Writing Measurable Learning Outcomes Sandi Osters, Di.docx

Writing Measurable Learning Outcomes
Sandi Osters, Director of Student Life Studies
F. Simone Tiu, Assistant Director for Institutional Effectiveness
3rd Annual Texas A&M Assessment Conference
You got to be careful if you don’t know where you’re going,
because you might not get there – Yogi Berra
Assessment is a systematic and on-going process of collecting,
interpreting,
and acting on information relating to the goals and outcomes
developed to
support the institution’s mission and purpose. It answers the
questions: (1)
What we are trying to do? (2) How well are we doing it? And
(3) How can we
improve what we are doing? Assessment begins with the
articulation of
outcomes. Writing measurable outcomes involves describing the
first three
components: outcome, assessment method, criteria for success,
in the
assessment cycle.

Assessment CycleAssessment Cycle
Outcome
Assessment
Method
Criteria for
Success
Assessment
Results
Use of
Results
Broadly speaking, there are two types of outcomes: learning
outcomes and
program outcomes. Learning outcomes describe what students
are expected
to demonstrate and program outcomes describe what a program
is expected

to accomplish.
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Learning Outcomes
Learning outcomes describe what students are able to
demonstrate in terms
of knowledge, skills, and values upon completion of a course, a
span of several
courses, or a program. Clear articulation of learning outcomes
serves as the
foundation to evaluating the effectiveness of the teaching and
learning
process.
The Components of a Measurable Learning Outcome. Three
essential
components of a measurable learning outcome are:
t learning behaviors
When writing a measurable learning outcome, it is important to:

focus on student behavior
use simple, specific action verbs
select appropriate assessment methods
state desired performance criteria
Focus on Student Behavior. Learning outcomes are about what
students are
able to demonstrate upon completion of a course or a span of
courses or a
program. Learning outcomes are not about what the instructors
can provide
but what the students can demonstrate. The following are not
learning
outcomes:
Offer opportunities for students to master integrated use of
information technology.
The program will engage a significant number of students in a
formalized language/cultural studies program.
Students who participate in critical writing seminars will write
two
essays on critical thinking skills.
Students will be exposed to exceptionality in learning
disabilities
including visual and perception disabilities.

Use Simple, Specific Action Verbs. When writing learning
outcomes, focus on
student behavior and use simple, specific action verbs to
describe what
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students are expected to demonstrate. The wording should be
something as
follows:
Students will be able to <action verbs> . . . .”
The following are examples of learning outcomes:
a. Students will be able to collect and organize appropriate
clinical data
(history, physical exam, laboratory assessments including
technology
advancements in diagnostic such as PCR).
b. Students will be able to apply principles of evidence-based
medicine to
determine clinical diagnoses, and formulate and implement
acceptable
treatment modalities.
c. Students will be able to articulate cultural and socioeconomic
differences and the significance of these differences for
instructional planning.

d. Students will be able to use technology effectively in the
delivery of
instruction, assessment, and professional development.
e. Students will be able to evaluate the need for assistance
technology
for their students.
f. Graduates will be able to evaluate educational research
critically and
participate in the research community.
g. Students will appreciate the value of outcomes assessment in
assuring
quality across the veterinary medical profession and in
facilitating
movement of the veterinary medical professionals across
national
borders.
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Note: Bloom’s Taxonomy can be a useful resource in
developing learning
outcomes. The following are action verbs that can be used for
various levels
of cognitive, affective, and psychomotor learning.
ACTION VERBS
Concrete verbs such as “define,” “apply,” or “analyze” are more
helpful for assessment than verbs such
as “be exposed to,” “understand,” “know,” “be familiar with.”

Cognitive Learning Action Verbs:
Knowledge - to recall or remember
facts without necessarily understanding
them
arrange, define, duplicate, label list, memorize, name, order,
recognize, relate, recall, reproduce, list, tell, describe,
identify, show, label, collect, examine, tabulate, quote
Comprehension – to understand and
interpret learned information
classify, describe, discuss, explain, express, interpret,
contrast, predict, associate, distinguish, estimate,
differentiate, discuss, extend, translate, review, restate,
locate, recognize, report
Application – to put ideas and concepts
to work in solving problems
apply, choose, demonstrate, dramatize, employ, illustrate,
interpret, operate, practice, schedule, sketch, solve, use,
calculate, complete, show, examine, modify, relate, change,
experiment, discover
Analysis – to break information into its
components to see interrelationships and
ideas
analyze, appraise, calculate, categorize, compare, contrast,
criticize, differentiate, discriminate, distinguish, examine,

experiment, question, test, separate, order, connect, classify,
arrange, divide, infer
Synthesis – to use creativity to compose
and design something original
arrange, assemble, collect, compose, construct, create,
design, develop, formulate, manage, organize, plan, prepare,
propose, set up, rewrite, integrate, create, design, generalize
Evaluation – to judge the value of
information based on established criteria
appraise, argue, assess, attach, defend, judge, predict, rate,
support, evaluate, recommend, convince, judge, conclude,
compare, summarize
Affective Learning appreciate, accept, attempt, challenge,
defend, dispute, join,
judge, praise, question, share, support
Psychomotor Learning bend, grasp, handle, operate, reach,
relax, shorten, stretch,
differentiate (by touch), express (facially), perform
(skillfully)
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Select Appropriate Assessment Methods. Assessment methods
are tools and
techniques used to determine the extent to which the stated
learning
outcomes are achieved. A variety of methods, qualitative and
quantitative,
direct and indirect, should be used. The following are examples
of direct and
indirect assessment methods:
Examples of Direct Assessment Methods: Examples of Indirect
Assessment Methods:
Comprehensive exams
Performance assessment for graduating
seniors
Writing proficiency exams
National Major Field Achievement Tests
GRE subject exams
Certification exams, licensure exams
Locally developed pre- and post- tests
Senior thesis / major project
Portfolio evaluation
Reflective journals
Capstone courses
Internship evaluations
Grading with scoring rubrics*
Peer institutions comparison
Job placement
Employer surveys
Graduate school acceptance rates
Performance in graduate school
Student graduation/retention rates
Exit interviews

Focus group discussions
Alumni surveys
Tracking of alumni awards, achievements
(national, state, international, etc.)
Curriculum/syllabus analysis
*Note: Grades alone do not provide adequate feedback to
students’ performance. However, if
grading is tied to rubrics, it can be a useful tool to identify
strengths and weaknesses of student
performance.
State Desired Performance Criteria. Performance criteria
express in
specific and measurable/observable terms that are acceptable to
a specific
course or program. Note that grades alone do not provide
adequate
feedback to students’ performance because grades represent
overall
competency of students and do not identify strengths and
weaknesses on
specific learning outcomes. However, if the grading system is
tied to rubrics,
it can be a useful tool to identify areas for improvement that
should be
addressed. The following is not an acceptable measurable
learning outcome:
Students will be able to communicate effectively, as
demonstrated by
obtaining at least a “C” grade in the course.

With slight modification, the above learning outcome can be
stated in
measurable terms.
Students will be able to communicate effectively, as exhibited
by
scoring at least 8 out of 10 for all the components within the
grading
criteria on the final writing assignment. (see below for an
example of
grading rubric and how it can help identify areas for
improvement)
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SS
ClCl
C
at
C
at
inin
Use vpuUse vpu
Use Use

Use cpUse cp
PP
DeDe
DemDem
8.0799697888910. Summarize the main idea(s) clearly
8.699888999899. onstrate good reasoning in writing
8.699888999898. velop patterns or organization for ideas
7.969989689877. resent accurate information
7.969999669886. orrect grammar, syntax (word order),
unctuation, and spelling
7.3*69768677895. correct reference forms
8.079969788894. ocabulary appropriate to their subject and
rpose(s)
7.988969779883. onsider how an audience will use the
formation
7.4*88767787882. early understand the audiences’ values,
titudes, goals, and needs
7.998968778891. tate the purpose clearly
Ave#10#9#8#7#6#5#4#3#2#1
StudentGrading Criteria
8.0799697888910. Summarize the main idea(s) clearly

8.699888999899. onstrate good reasoning in writing
8.699888999898. velop patterns or organization for ideas
7.969989689877. resent accurate information
7.969999669886. orrect grammar, syntax (word order),
unctuation, and spelling
7.3*69768677895. correct reference forms
8.079969788894. ocabulary appropriate to their subject and
rpose(s)
7.988969779883. onsider how an audience will use the
formation
7.4*88767787882. early understand the audiences’ values,
titudes, goals, and needs
7.998968778891. tate the purpose clearly
Ave#10#9#8#7#6#5#4#3#2#1
StudentGrading Criteria
Areas for
Improvement
Example of a Grading Rubric
Examples of criteria for success:
Grading with a scoring rubric:

All Students will score an average of 8.00. Of the ten grading
criteria,
none will score less than 7.50.
Standardized test:
Sixty-five percent of all students will score at or above the
national
average. No more than 20% will score lower than one standard
deviation
from the national average.
Survey:
Eighty percent of students surveyed will demonstrate an
increase in
appreciation for . . . .
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Examples of Measurable Learning Outcomes. The following
examples are
taken from the Doctor of Veterinary Medicine program from
Texas A&M.
Direct method used: Standardized Exams

Learning Outcome (knowledge based):
Students will demonstrate mastery of basic principles of gross
and microscopic anatomy,
physiology, biochemistry, immunology, microbiology/virology
(including knowledge of
foreign diseases such as foot and mouth disease and bovine
spongioform encephalopathy
(mad cow disease) and diseases with bioterrorism potential such
as anthrax) . . . .
Assessment Method:
The National Board of Medical Examiners (NBME) Subject
(Shelf) Exams will be used. The
NBME is given to medical students in preparation for a Phase I
(preclinical) exam
administered at the end of the second year of a professional
medical curriculum. The exam
provides a multiple choice exam(s) that addresses the core
competencies noted in pre-clinical
learning outcomes, provides national norming and a
psychometrically sound and legally
defensible test preparation method, and concentrates on
integration of knowledge rather than
simple recall of isolated facts.
Outcomes Criteria:
o Ninety percent of all students will score at least 70% or better
on this exam. Of the ten

categories represented on the exam, students will achieve the
passing mark of 70% on at least
8 of 10 categories.
o Sixty-five percent of all will score at or above the national
average established using data
collected from second year medical students. No more than 20%
will score lower than one
standard deviation from the national average.
Indirect method used: Survey
Learning Outcome (attitude based):
Students will appreciate the value of outcomes assessments in
assuring quality across the
veterinary medical profession and in facilitating movement of
veterinary medical
professionals across national borders.
Assessment Method:
The appreciation for the value of standard setting to promote
veterinary medical globalization
and international opportunities will be assessed at the beginning
and end of the professional
curriculum through completion of an appropriately designed
survey.
Outcomes Criteria:
o Eighty percent of students surveyed will demonstrate an

increase in appreciation for
outcomes assessment to assure quality across the profession and
facilitating movement of
the profession across national borders.
7 of 10
Direct method used: pre- and post- evaluation of written cases
Learning Outcomes (skill based):
Students will be able to collect and organize appropriate
clinical date (history, physical exam,
laboratory assessments including technological advancements in
diagnostics such as PCR).
Students will be able to apply principles of evidence-based
medicine to determine clinical
diagnoses . . . .
Assessment Method:
A series of written cases (based on medical records) as well as
actual clinical cases will be
utilized to assess clinical competencies of students immediately
prior to and at the end of
their fourth (clinical) year. The written cases are developed
using established expertise. A

system for utilization of actual clinical cases for pre- and post-
assessment will be developed
for a cohort of students.
Outcomes Criteria:
o All students will show substantial improvement in stated
learning outcomes as indicated by
pre- and post- evaluation of written cases.
Program and Performance Outcomes
Program and performance outcomes describe what you want a
program to do
or accomplish rather than what you want students to know, do
or value.
Program outcomes can be as simple as a completion of a task or
activity,
although this is not as meaningful as it could be and does not
provide you
information for improvement. To accomplish the latter, you
should try to
assess the effectiveness of what you want your program to
accomplish.
Performance outcomes usually have quantitative targets.
The Components of a Measurable Program Outcome are the
same as for
learning outcomes except the actor is the program not the
student. Some of
the more commonly used assessment methods for evaluating

program
outcomes include the following:
Examples of Direct Assessment Methods: Examples of Indirect
Assessment Methods:
Tracking use of services (attendance, ticket
sales, clients, etc.)
Tracking program participation by desired
demographics
Satisfaction surveys
Focus group discussions
GPA
Timelines and budgets
Certificates of completion/compliance
Peer institutions benchmarking
Observation
Former student surveys
Student leadership transcripts
8 of 10
The following are examples of program/performance outcomes:
Performance outcome: Increase the size of the Rec Center’s
Weight & Fitness room and
purchase additional equipment to increase access for Rec Center
members. (Dependent on the
successful passage of the student fee referendum.)
Means of assessment: Completion of project by September 1,

2005, within budgetary
constraints; a customer satisfaction survey both pre- and post-
construction; comparison of hourly
counts of users pre- and post-construction
Criteria for Success: Completion of project by September 1,
2005, within budgetary
constraints; Minimum inconvenience to current weight room
users during construction;
aesthetically pleasing addition; increase in number of
participants and pieces of equipment in
weight room; increased level of customer satisfaction with the
weight room.
Performance outcome: Develop and expand the Student Health
Services web page in order to
increase student access to health information, information
regarding patient services and
educational programming available from Student Health
Services
Means of assessment: (1) Data retrieval from webpage
interactions; (2) Annual patient survey to
determine student utilization of website; (3) Survey instruments
utilized by Health Education
when scheduling of evaluating Health Education programs to
determine student utilization of
website.
Criteria for Success: Increase in the utilization of the Student
Health Services webpage
regarding health information, patient services and educational
programming

Performance Outcome: Corps of Cadets semester GPA will
increase by 1% a semester for three
years beginning with the Spring of 2003
Means of Assessment: Computing GPA at the end of each
semester and comparing it to the
previous spring or fall semester as appropriate.
Criteria for Success: Spring for Spring 03 will be 2.7213;
Spring 04 will be 2.7485; Spring 05
will be 2.7760; Fall of 03 will be 2.6913; Fall 04 will be
2.7182; Fall 05 will be 2.7454.
Summation
1. Be very clear about what you are trying to assess. Do you
want to assess
what your program is accomplishing and the degree to which it
is being
accomplished (program outcomes)? Do you want to assess what
students
are learning or what staff is learning as a result of the
curriculum or
training your program is offering (learning outcomes)?
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2. Are your outcomes measuring something useful and
meaningful? Will
relevant parties find the information generated credible and
applicable
to decisions that need to be made?
3. Is the outcome measurable? If it is not, you need to redefine
your
outcome.
4. Be patient. Try not to be frustrated with the process and seek
assistance from others. Asking others to evaluate your
outcomes is a
good way to improve them. Writing good outcomes takes
practice, and it
takes time.
5. Practice, practice, practice.
6. Celebrate your accomplishments. Writing good outcomes
will suggest
good measurements. Good measurements will provide the
information to
continuously improve your program.
On-line Resources:
http://www.ncgia.ucsb.edu/education/curricula/giscc/units/form
at/outcome
s.html

http://www.depts.washington.edu/grading/slo/designing_outcom
es.htm
http://www.aahe.org/assessment/assessmentplan.htm
http://www.ac.wwu.edu/~assess/slo.htm (includes books on
assessment and
student learning)
Contact Us: Please feel free to contact Simone Tiu at
[email protected]
or Sandi Osters at [email protected], we would be happy to
provide feedback
on your effort in articulating measurable learning outcomes.
at/outcomes.html
at/outcomes.html
http://www.depts.washington.edu/grading/slo/designing_outcom
es.htm
http://www.aahe.org/assessment/assessmentplan.htm
http://www.ac.wwu.edu/~assess/slo.htm
mailto:[email protected]
mailto:[email protected]Learning OutcomesACTION
VERBSAffective LearningPsychomotor Learning
www.hbrreprints.org
B
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OF
HBR
Leading Change
Why Transformation Efforts Fail
by John P. Kotter
•
Included with this full-text
Harvard Business Review
article:
The Idea in Brief—the core idea
The Idea in Practice—putting the idea to work
1

Article Summary
2
Leading Change: Why Transformation Efforts Fail
A list of related materials, with annotations to guide further
exploration of the article’s ideas and applications
10
Further Reading
Leaders who successfully
transform businesses do eight
things right (and they do them
in the right order).
Reprint R0701J
This document is authorized for use only in Laureate Education,
Inc. 's WAL NURS 8500 Evidence Based Practice II: Planning
& Implementation at Laureate Education - Baltimore from Feb
2018 to Apr 2019.
http://harvardbusinessonline.hbsp.harvard.edu/relay.jhtml?name
=itemdetail&referral=4320&id=R0701J
http://www.hbrreprints.org

B
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Leading Change
page 1
The Idea in Brief The Idea in Practice
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Most major change initiatives—whether in-
tended to boost quality, improve culture, or
reverse a corporate death spiral—generate
only lukewarm results. Many fail miserably.
Why? Kotter maintains that too many
managers don’t realize transformation is a
process,
not an event. It advances through
stages that build on each other. And it
takes years. Pressured to accelerate the
process, managers skip stages. But short-
cuts never work.
Equally troubling, even highly capable
managers make critical mistakes—such as
declaring victory too soon. Result? Loss of

momentum, reversal of hard-won gains,
and devastation of the entire transforma-
tion effort.
By understanding the stages of change—
and the pitfalls unique to each stage—you
boost your chances of a successful transfor-
mation. The payoff? Your organization flexes
with tectonic shifts in competitors, markets,
and technologies—leaving rivals far behind.
To give your transformation effort the best chance of
succeeding, take the right actions at each
stage—and avoid common pitfalls.
Stage Actions Needed Pitfalls
Establish a
sense of
urgency
• Examine market and competitive reali-
ties for potential crises and untapped
opportunities.
• Convince at least 75% of your man-
agers that the status quo is more dan-
gerous than the unknown.
• Underestimating the difficulty of driving
people from their comfort zones
• Becoming paralyzed by risks
Form a pow-
erful guiding

coalition
• Assemble a group with shared commit-
ment and enough power to lead the
change effort.
• Encourage them to work as a team
outside the normal hierarchy.
• No prior experience in teamwork at the
top
• Relegating team leadership to an HR,
quality, or strategic-planning executive
rather than a senior line manager
Create a
vision
• Create a vision to direct the change effort.
• Develop strategies for realizing that vision.
• Presenting a vision that’s too complicat-
ed or vague to be communicated in five
minutes
Communicate
the vision
• Use every vehicle possible to commu-
nicate the new vision and strategies for
achieving it.
• Teach new behaviors by the example of
the guiding coalition.

• Undercommunicating the vision
• Behaving in ways antithetical to the
vision
Empower
others to act
on the vision
• Remove or alter systems or structures
undermining the vision.
• Encourage risk taking and nontradition-
al ideas, activities, and actions.
• Failing to remove powerful individuals
who resist the change effort
Plan for and
create short-
term wins
• Define and engineer visible perform-
ance improvements.
• Recognize and reward employees con-
tributing to those improvements.
• Leaving short-term successes up to
chance
• Failing to score successes early enough
(12-24 months into the change effort)
Consolidate

improve-
ments and
produce
more change
• Use increased credibility from early
wins to change systems, structures, and
policies undermining the vision.
• Hire, promote, and develop employees
who can implement the vision.
• Reinvigorate the change process with
new projects and change agents.
• Declaring victory too soon—with the
first performance improvement
• Allowing resistors to convince “troops”
that the war has been won
Institutionalize
new
approaches
• Articulate connections between new
behaviors and corporate success.
• Create leadership development and
succession plans consistent with the
new approach.
• Not creating new social norms and
shared values consistent with changes
• Promoting people into leadership posi-

tions who don’t personify the new
approach
2018 to Apr 2019.
B
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Leading Change
by John P. Kotter
harvard business review • january 2007 page 2

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Leaders who successfully transform businesses do eight things
right
(and they do them in the right order).
Editor’s Note:
Guiding change may be the ulti-
mate test of a leader—no business survives over
the long term if it can’t reinvent itself. But,
human nature being what it is, fundamental

change is often resisted mightily by the people it
most affects: those in the trenches of the busi-
ness. Thus, leading change is both absolutely es-
sential and incredibly difficult.
Perhaps nobody understands the anatomy
of organizational change better than retired
Harvard Business School professor John P.
Kotter. This article, originally published in the
spring of 1995, previewed Kotter’s 1996 book
Leading Change
. It outlines eight critical suc-
cess factors—from establishing a sense of ex-
traordinary urgency, to creating short-term
wins, to changing the culture (“the way we do
things around here”). It will feel familiar when
you read it, in part because Kotter’s vocabulary
has entered the lexicon and in part because it
contains the kind of home truths that we recog-
nize, immediately, as if we’d always known
them. A decade later, his work on leading
change remains definitive.
Over the past decade, I have watched more
than 100 companies try to remake themselves
into significantly better competitors. They
have included large organizations (Ford) and
small ones (Landmark Communications),
companies based in the United States (Gen-
eral Motors) and elsewhere (British Airways),
corporations that were on their knees (Eastern

Airlines), and companies that were earning
good money (Bristol-Myers Squibb). These ef-
forts have gone under many banners: total
quality management, reengineering, rightsiz-
ing, restructuring, cultural change, and turn-
around. But, in almost every case, the basic
goal has been the same: to make fundamental
changes in how business is conducted in order
to help cope with a new, more challenging
market environment.
A few of these corporate change efforts have
been very successful. A few have been utter
failures. Most fall somewhere in between, with
a distinct tilt toward the lower end of the scale.
The lessons that can be drawn are interesting
and will probably be relevant to even more or-
2018 to Apr 2019.
Leading Change
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B
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ganizations in the increasingly competitive
business environment of the coming decade.
The most general lesson to be learned from
the more successful cases is that the change
process goes through a series of phases that, in
total, usually require a considerable length of
time. Skipping steps creates only the illusion of
speed and never produces a satisfying result. A
second very general lesson is that critical mis-
takes in any of the phases can have a devastat-
ing impact, slowing momentum and negating
hard-won gains. Perhaps because we have rela-
tively little experience in renewing organiza-
tions, even very capable people often make at
least one big error.

Error 1: Not Establishing a Great
Enough Sense of Urgency
Most successful change efforts begin when
some individuals or some groups start to look
hard at a company’s competitive situation,
market position, technological trends, and fi-
nancial performance. They focus on the po-
tential revenue drop when an important
patent expires, the five-year trend in declining
margins in a core business, or an emerging
market that everyone seems to be ignoring.
They then find ways to communicate this in-
formation broadly and dramatically, especially
with respect to crises, potential crises, or great
opportunities that are very timely. This first
step is essential because just getting a transfor-
mation program started requires the aggres-
sive cooperation of many individuals. Without
motivation, people won’t help, and the effort
goes nowhere.
Compared with other steps in the change
process, phase one can sound easy. It is not.
Well over 50% of the companies I have
watched fail in this first phase. What are the
reasons for that failure? Sometimes executives
underestimate how hard it can be to drive peo-
ple out of their comfort zones. Sometimes they
grossly overestimate how successful they have
already been in increasing urgency. Sometimes
they lack patience: “Enough with the prelimi-
naries; let’s get on with it.” In many cases, exec-
utives become paralyzed by the downside pos-
sibilities. They worry that employees with

seniority will become defensive, that morale
will drop, that events will spin out of control,
that short-term business results will be jeopar-
dized, that the stock will sink, and that they
will be blamed for creating a crisis.
A paralyzed senior management often comes
from having too many managers and not
enough leaders. Management’s mandate is to
minimize risk and to keep the current system
operating. Change, by definition, requires cre-
ating a new system, which in turn always de-
mands leadership. Phase one in a renewal
process typically goes nowhere until enough
real leaders are promoted or hired into senior-
level jobs.
Transformations often begin, and begin
well, when an organization has a new head
who is a good leader and who sees the need for
a major change. If the renewal target is the en-
tire company, the CEO is key. If change is
needed in a division, the division general man-
ager is key. When these individuals are not new
leaders, great leaders, or change champions,
phase one can be a huge challenge.
Bad business results are both a blessing and
a curse in the first phase. On the positive side,
losing money does catch people’s attention.
But it also gives less maneuvering room. With
good business results, the opposite is true: Con-
vincing people of the need for change is much
harder, but you have more resources to help
make changes.

But whether the starting point is good per-
formance or bad, in the more successful cases I
have witnessed, an individual or a group al-
ways facilitates a frank discussion of poten-
tially unpleasant facts about new competition,
shrinking margins, decreasing market share,
flat earnings, a lack of revenue growth, or
other relevant indices of a declining competi-
tive position. Because there seems to be an al-
most universal human tendency to shoot the
bearer of bad news, especially if the head of
the organization is not a change champion, ex-
ecutives in these companies often rely on out-
siders to bring unwanted information. Wall
Street analysts, customers, and consultants can
all be helpful in this regard. The purpose of all
this activity, in the words of one former CEO of
a large European company, is “to make the sta-
tus quo seem more dangerous than launching
into the unknown.”
In a few of the most successful cases, a group
has manufactured a crisis. One CEO deliber-
ately engineered the largest accounting loss in
the company’s history, creating huge pressures
from Wall Street in the process. One division
president commissioned first-ever customer
satisfaction surveys, knowing full well that the
Now retired,
John P. Kotter

was the
Konosuke Matsushita Professor of
Leadership at Harvard Business School
in Boston.
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results would be terrible. He then made these
findings public. On the surface, such moves can
look unduly risky. But there is also risk in play-
ing it too safe: When the urgency rate is not
pumped up enough, the transformation pro-
cess cannot succeed, and the long-term future
of the organization is put in jeopardy.
When is the urgency rate high enough?
From what I have seen, the answer is when
about 75% of a company’s management is hon-
estly convinced that business as usual is totally
unacceptable. Anything less can produce very
serious problems later on in the process.
Error 2: Not Creating a Powerful
Enough Guiding Coalition
Major renewal programs often start with just
one or two people. In cases of successful trans-
formation efforts, the leadership coalition
grows and grows over time. But whenever
some minimum mass is not achieved early in
the effort, nothing much worthwhile happens.
It is often said that major change is impos-
sible unless the head of the organization is an
active supporter. What I am talking about

goes far beyond that. In successful transfor-
mations, the chairman or president or divi-
sion general manager, plus another five or
15 or 50 people, come together and develop
a shared commitment to excellent perfor-
mance through renewal. In my experience,
this group never includes all of the company’s
most senior executives because some people
just won’t buy in, at least not at first. But in
the most successful cases, the coalition is
always pretty powerful—in terms of titles,
EIGHT STEPS TO TRANSFORMING
YOUR ORGANIZATION
Establishing a Sense of Urgency
• Examining market and competitive realities
• Identifying and discussing crises, potential crises, or major
opportunities
Forming a Powerful Guiding Coalition
• Assembling a group with enough power to lead the change
effort
• Encouraging the group to work together as a team
Creating a Vision
• Creating a vision to help direct the change effort
• Developing strategies for achieving that vision
Communicating the Vision
• Using every vehicle possible to communicate the new vision
and strategies

• Teaching new behaviors by the example of the guiding
coalition
Empowering Others to Act on the Vision
• Getting rid of obstacles to change
• Changing systems or structures that seriously undermine the
vision
• Encouraging risk taking and nontraditional ideas, activities,
and actions
Planning for and Creating Short-Term Wins
• Planning for visible performance improvements
• Creating those improvements
• Recognizing and rewarding employees involved in the
improvements
Consolidating Improvements and Producing Still More Change
• Using increased credibility to change systems, structures, and
policies that
don’t fit the vision
• Hiring, promoting, and developing employees who can
implement the vision
• Reinvigorating the process with new projects, themes, and
change agents
Institutionalizing New Approaches
• Articulating the connections between the new behaviors and
corporate
success
• Developing the means to ensure leadership development and

succession
1
2
3
4
5
6
7
8
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information and expertise, reputations, and
relationships.
In both small and large organizations, a suc-
cessful guiding team may consist of only three
to five people during the first year of a renewal
effort. But in big companies, the coalition
needs to grow to the 20 to 50 range before
much progress can be made in phase three and
beyond. Senior managers always form the
core of the group. But sometimes you find
board members, a representative from a key
customer, or even a powerful union leader.
Because the guiding coalition includes mem-
bers who are not part of senior management,
it tends to operate outside of the normal hier-
archy by definition. This can be awkward, but

it is clearly necessary. If the existing hierarchy
were working well, there would be no need for
a major transformation. But since the current
system is not working, reform generally de-
mands activity outside of formal boundaries,
expectations, and protocol.
A high sense of urgency within the manage-
rial ranks helps enormously in putting a guid-
ing coalition together. But more is usually re-
quired. Someone needs to get these people
together, help them develop a shared assess-
ment of their company’s problems and oppor-
tunities, and create a minimum level of trust
and communication. Off-site retreats, for two
or three days, are one popular vehicle for ac-
complishing this task. I have seen many groups
of five to 35 executives attend a series of these
retreats over a period of months.
Companies that fail in phase two usually un-
derestimate the difficulties of producing change
and thus the importance of a powerful guiding
coalition. Sometimes they have no history of
teamwork at the top and therefore undervalue
the importance of this type of coalition. Some-
times they expect the team to be led by a staff
executive from human resources, quality, or
strategic planning instead of a key line man-
ager. No matter how capable or dedicated the
staff head, groups without strong line leader-
ship never achieve the power that is required.
Efforts that don’t have a powerful enough
guiding coalition can make apparent progress
for a while. But, sooner or later, the opposition

gathers itself together and stops the change.
Error 3: Lacking a Vision
In every successful transformation effort that I
have seen, the guiding coalition develops a
picture of the future that is relatively easy to
communicate and appeals to customers, stock-
holders, and employees. A vision always goes
beyond the numbers that are typically found
in five-year plans. A vision says something that
helps clarify the direction in which an organi-
zation needs to move. Sometimes the first
draft comes mostly from a single individual. It
is usually a bit blurry, at least initially. But
after the coalition works at it for three or five
or even 12 months, something much better
emerges through their tough analytical think-
ing and a little dreaming. Eventually, a strat-
egy for achieving that vision is also developed.
In one midsize European company, the first
pass at a vision contained two-thirds of the
basic ideas that were in the final product. The
concept of global reach was in the initial ver-
sion from the beginning. So was the idea of be-
coming preeminent in certain businesses. But
one central idea in the final version—getting
out of low value-added activities—came only
after a series of discussions over a period of
several months.
Without a sensible vision, a transformation

effort can easily dissolve into a list of confus-
ing and incompatible projects that can take
the organization in the wrong direction or
nowhere at all. Without a sound vision, the
reengineering project in the accounting de-
partment, the new 360-degree performance
appraisal from the human resources depart-
ment, the plant’s quality program, the cul-
tural change project in the sales force will not
add up in a meaningful way.
In failed transformations, you often find
plenty of plans, directives, and programs but
no vision. In one case, a company gave out
four-inch-thick notebooks describing its change
effort. In mind-numbing detail, the books
spelled out procedures, goals, methods, and
deadlines. But nowhere was there a clear and
compelling statement of where all this was
leading. Not surprisingly, most of the employ-
ees with whom I talked were either confused
or alienated. The big, thick books did not rally
them together or inspire change. In fact, they
probably had just the opposite effect.
In a few of the less successful cases that I
have seen, management had a sense of direc-
tion, but it was too complicated or blurry to
be useful. Recently, I asked an executive in a
midsize company to describe his vision and re-
ceived in return a barely comprehensible 30-
If you can’t communicate
the vision to someone in
five minutes or less and
get a reaction that

signifies both
understanding and
interest, you are not
done.
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minute lecture. Buried in his answer were the
basic elements of a sound vision. But they were
buried—deeply.
A useful rule of thumb: If you can’t commu-
nicate the vision to someone in five minutes or
less and get a reaction that signifies both un-
derstanding and interest, you are not yet done
with this phase of the transformation process.
Error 4: Undercommunicating the
Vision by a Factor of Ten
I’ve seen three patterns with respect to com-
munication, all very common. In the first, a
group actually does develop a pretty good
transformation vision and then proceeds to
communicate it by holding a single meeting or
sending out a single communication. Having
used about 0.0001% of the yearly intracom-
pany communication, the group is startled
when few people seem to understand the new
approach. In the second pattern, the head of
the organization spends a considerable amount
of time making speeches to employee groups,
but most people still don’t get it (not surpris-
ing, since vision captures only 0.0005% of the
total yearly communication). In the third pat-
tern, much more effort goes into newsletters

and speeches, but some very visible senior ex-
ecutives still behave in ways that are antitheti-
cal to the vision. The net result is that cynicism
among the troops goes up, while belief in the
communication goes down.
Transformation is impossible unless hun-
dreds or thousands of people are willing to
help, often to the point of making short-term
sacrifices. Employees will not make sacrifices,
even if they are unhappy with the status quo,
unless they believe that useful change is possi-
ble. Without credible communication, and a
lot of it, the hearts and minds of the troops are
never captured.
This fourth phase is particularly challenging
if the short-term sacrifices include job losses.
Gaining understanding and support is tough
when downsizing is a part of the vision. For
this reason, successful visions usually include
new growth possibilities and the commitment
to treat fairly anyone who is laid off.
Executives who communicate well incorpo-
rate messages into their hour-by-hour activi-
ties. In a routine discussion about a business
problem, they talk about how proposed solu-
tions fit (or don’t fit) into the bigger picture. In
a regular performance appraisal, they talk
about how the employee’s behavior helps or
undermines the vision. In a review of a divi-
sion’s quarterly performance, they talk not
only about the numbers but also about how
the division’s executives are contributing to the

transformation. In a routine Q&A with em-
ployees at a company facility, they tie their an-
swers back to renewal goals.
In more successful transformation efforts,
executives use all existing communication
channels to broadcast the vision. They turn
boring, unread company newsletters into lively
articles about the vision. They take ritualistic,
tedious quarterly management meetings and
turn them into exciting discussions of the
transformation. They throw out much of the
company’s generic management education
and replace it with courses that focus on busi-
ness problems and the new vision. The guiding
principle is simple: Use every possible channel,
especially those that are being wasted on non-
essential information.
Perhaps even more important, most of the
executives I have known in successful cases of
major change learn to “walk the talk.” They
consciously attempt to become a living symbol
of the new corporate culture. This is often not
easy. A 60-year-old plant manager who has
spent precious little time over 40 years think-
ing about customers will not suddenly behave
in a customer-oriented way. But I have wit-
nessed just such a person change, and change a
great deal. In that case, a high level of urgency
helped. The fact that the man was a part of the
guiding coalition and the vision-creation team
also helped. So did all the communication,
which kept reminding him of the desired be-
havior, and all the feedback from his peers and
subordinates, which helped him see when he

was not engaging in that behavior.
Communication comes in both words and
deeds, and the latter are often the most power-
ful form. Nothing undermines change more
than behavior by important individuals that is
inconsistent with their words.
Error 5: Not Removing Obstacles to
the New Vision
Successful transformations begin to involve
large numbers of people as the process
progresses. Employees are emboldened to try
new approaches, to develop new ideas, and to
provide leadership. The only constraint is that
the actions fit within the broad parameters of
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the overall vision. The more people involved,
the better the outcome.
To some degree, a guiding coalition empow-
ers others to take action simply by successfully
communicating the new direction. But com-
munication is never sufficient by itself. Re-
newal also requires the removal of obstacles.
Too often, an employee understands the new
vision and wants to help make it happen, but
an elephant appears to be blocking the path.
In some cases, the elephant is in the person’s
head, and the challenge is to convince the indi-
vidual that no external obstacle exists. But in
most cases, the blockers are very real.

Sometimes the obstacle is the organizational
structure: Narrow job categories can seriously
undermine efforts to increase productivity
or make it very difficult even to think
about customers. Sometimes compensation
or performance-appraisal systems make peo-
ple choose between the new vision and their
own self-interest. Perhaps worst of all are bosses
who refuse to change and who make demands
that are inconsistent with the overall effort.
One company began its transformation pro-
cess with much publicity and actually made
good progress through the fourth phase. Then
the change effort ground to a halt because the
officer in charge of the company’s largest divi-
sion was allowed to undermine most of the
new initiatives. He paid lip service to the pro-
cess but did not change his behavior or encour-
age his managers to change. He did not reward
the unconventional ideas called for in the vi-
sion. He allowed human resource systems to
remain intact even when they were clearly in-
consistent with the new ideals. I think the of-
ficer’s motives were complex. To some degree,
he did not believe the company needed major
change. To some degree, he felt personally threat-
ened by all the change. To some degree, he was
afraid that he could not produce both change
and the expected operating profit. But despite
the fact that they backed the renewal effort,
the other officers did virtually nothing to stop
the one blocker. Again, the reasons were com-
plex. The company had no history of confront-
ing problems like this. Some people were afraid
of the officer. The CEO was concerned that he

might lose a talented executive. The net result
was disastrous. Lower-level managers concluded
that senior management had lied to them
about their commitment to renewal, cynicism
grew, and the whole effort collapsed.
In the first half of a transformation, no orga-
nization has the momentum, power, or time to
get rid of all obstacles. But the big ones must
be confronted and removed. If the blocker is a
person, it is important that he or she be
treated fairly and in a way that is consistent
with the new vision. Action is essential, both
to empower others and to maintain the credi-
bility of the change effort as a whole.
Error 6: Not Systematically Planning
for, and Creating, Short-Term Wins
Real transformation takes time, and a renewal
effort risks losing momentum if there are no
short-term goals to meet and celebrate. Most
people won’t go on the long march unless they
see compelling evidence in 12 to 24 months
that the journey is producing expected results.
Without short-term wins, too many people
give up or actively join the ranks of those peo-
ple who have been resisting change.
One to two years into a successful transfor-
mation effort, you find quality beginning to go
up on certain indices or the decline in net in-
come stopping. You find some successful new
product introductions or an upward shift in

market share. You find an impressive produc-
tivity improvement or a statistically higher cus-
tomer satisfaction rating. But whatever the
case, the win is unambiguous. The result is not
just a judgment call that can be discounted by
those opposing change.
Creating short-term wins is different from
hoping for short-term wins. The latter is pas-
sive, the former active. In a successful transfor-
mation, managers actively look for ways to ob-
tain clear performance improvements, establish
goals in the yearly planning system, achieve
the objectives, and reward the people involved
with recognition, promotions, and even money.
For example, the guiding coalition at a U.S.
manufacturing company produced a highly
visible and successful new product introduc-
tion about 20 months after the start of its re-
newal effort. The new product was selected
about six months into the effort because it met
multiple criteria: It could be designed and
launched in a relatively short period, it could
be handled by a small team of people who
were devoted to the new vision, it had upside
potential, and the new product-development
team could operate outside the established de-
partmental structure without practical prob-
lems. Little was left to chance, and the win
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boosted the credibility of the renewal process.
Managers often complain about being forced
to produce short-term wins, but I’ve found that
pressure can be a useful element in a change
effort. When it becomes clear to people that

major change will take a long time, urgency
levels can drop. Commitments to produce
short-term wins help keep the urgency level up
and force detailed analytical thinking that can
clarify or revise visions.
Error 7: Declaring Victory Too Soon
After a few years of hard work, managers may
be tempted to declare victory with the first
clear performance improvement. While cele-
brating a win is fine, declaring the war won
can be catastrophic. Until changes sink deeply
into a company’s culture, a process that can
take five to ten years, new approaches are frag-
ile and subject to regression.
In the recent past, I have watched a dozen
change efforts operate under the reengineer-
ing theme. In all but two cases, victory was de-
clared and the expensive consultants were paid
and thanked when the first major project was
completed after two to three years. Within two
more years, the useful changes that had been
introduced slowly disappeared. In two of the
ten cases, it’s hard to find any trace of the re-
engineering work today.
Over the past 20 years, I’ve seen the same
sort of thing happen to huge quality projects,
organizational development efforts, and more.
Typically, the problems start early in the pro-
cess: The urgency level is not intense enough,
the guiding coalition is not powerful enough,

and the vision is not clear enough. But it is the
premature victory celebration that kills mo-
mentum. And then the powerful forces associ-
ated with tradition take over.
Ironically, it is often a combination of change
initiators and change resistors that creates the
premature victory celebration. In their enthu-
siasm over a clear sign of progress, the initia-
tors go overboard. They are then joined by re-
sistors, who are quick to spot any opportunity
to stop change. After the celebration is over,
the resistors point to the victory as a sign that
the war has been won and the troops should
be sent home. Weary troops allow themselves
to be convinced that they won. Once home,
the foot soldiers are reluctant to climb back on
the ships. Soon thereafter, change comes to a
halt, and tradition creeps back in.
Instead of declaring victory, leaders of suc-
cessful efforts use the credibility afforded by
short-term wins to tackle even bigger prob-
lems. They go after systems and structures that
are not consistent with the transformation vi-
sion and have not been confronted before.
They pay great attention to who is promoted,
who is hired, and how people are developed.
They include new reengineering projects that
are even bigger in scope than the initial ones.
They understand that renewal efforts take not
months but years. In fact, in one of the most
successful transformations that I have ever
seen, we quantified the amount of change that
occurred each year over a seven-year period.
On a scale of one (low) to ten (high), year one

received a two, year two a four, year three a
three, year four a seven, year five an eight, year
six a four, and year seven a two. The peak came
in year five, fully 36 months after the first set
of visible wins.
Error 8: Not Anchoring Changes in
the Corporation’s Culture
In the final analysis, change sticks when it be-
comes “the way we do things around here,”
when it seeps into the bloodstream of the cor-
porate body. Until new behaviors are rooted in
social norms and shared values, they are sub-
ject to degradation as soon as the pressure for
change is removed.
Two factors are particularly important in in-
stitutionalizing change in corporate culture.
The first is a conscious attempt to show people
how the new approaches, behaviors, and atti-
tudes have helped improve performance.
When people are left on their own to make
the connections, they sometimes create very
inaccurate links. For example, because results
improved while charismatic Harry was boss,
the troops link his mostly idiosyncratic style
with those results instead of seeing how their
own improved customer service and productiv-
ity were instrumental. Helping people see the
right connections requires communication. In-
deed, one company was relentless, and it paid
off enormously. Time was spent at every major
management meeting to discuss why perfor-

mance was increasing. The company news-
paper ran article after article showing how
changes had boosted earnings.
The second factor is taking sufficient time
to make sure that the next generation of top
management really does personify the new
After a few years of hard
work, managers may be
tempted to declare
victory with the first
clear performance
improvement. While
celebrating a win is fine,
declaring the war won
can be catastrophic.
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approach. If the requirements for promotion
don’t change, renewal rarely lasts. One bad
succession decision at the top of an organiza-
tion can undermine a decade of hard work.
Poor succession decisions are possible when
boards of directors are not an integral part of
the renewal effort. In at least three instances I
have seen, the champion for change was the
retiring executive, and although his successor
was not a resistor, he was not a change cham-
pion. Because the boards did not understand
the transformations in any detail, they could
not see that their choices were not good fits.
The retiring executive in one case tried unsuc-
cessfully to talk his board into a less seasoned
candidate who better personified the transfor-
mation. In the other two cases, the CEOs did
not resist the boards’ choices, because they

felt the transformation could not be undone
by their successors. They were wrong. Within
two years, signs of renewal began to disap-
pear at both companies.
• • •
There are still more mistakes that people
make, but these eight are the big ones. I realize
that in a short article everything is made to
sound a bit too simplistic. In reality, even
successful change efforts are messy and full
of surprises. But just as a relatively simple vi-
sion is needed to guide people through a
major change, so a vision of the change pro-
cess can reduce the error rate. And fewer er-
rors can spell the difference between success
and failure.
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page 10
Further Reading
A R T I C L E S
Building Your Company’s Vision
by James C. Collins and Jerry I. Porras
September–October 1996
Product no. 96501
Collins and Porras describe the glue that
holds a change effort together. Great compa-

nies have a clear sense of why they exist—
their core ideology—and where they want
to go—their envisioned future. The mecha-
nism for getting there is a BHAG (Big, Hairy,
Audacious Goal), which typically takes 10 to
30 years to accomplish. The company’s busi-
ness, strategies, and even its culture may
change, but its core ideology remains un-
changed. At every step in this long process,
the leader’s key task is to create alignment
with the vision of the company’s future, so
that regardless of the twists and turns in the
journey, the organizational commitment to
the goal remains strong.
Successful Change Programs Begin with
Results
by Robert H. Schaffer and Harvey A. Thomson
January–February 1992
Product no. 92108
Although a change initiative is a process, that
doesn’t mean process issues should be the
primary concern. Most corporate change
programs have a negligible impact on opera-
tional and financial performance because
management focuses on the activities, not

the results. By contrast, results-driven im-
provement programs seek to achieve spe-
cific, measurable improvements within a
few months.
B O O K S
The Heart of Change: Real-Life Stories of
How People Change Their Organizations
by John P. Kotter and Dan S. Cohen
Harvard Business School Press
2002
Product no. 2549
This book is organized around Kotter’s eight-
stage change process, and reveals the results
of his research in over 100 organizations in
the midst of large-scale change. Although
most organizations believe that change hap-
pens by making people think differently, the
authors say that the key lies more in making
them feel differently. They introduce a new
dynamic—“see-feel-change”—that sparks
and fuels action by showing people potent
reasons for change that charge their emo-
tions. The book offers tips and tools to you
apply to your own organization.
Leading Change

by John P. Kotter
Harvard Business School Press
1996
Product no. 7471
This book expands upon the article about why
transformation efforts fail. Kotter addresses
each of eight major stages of a change initia-
tive in sequence, highlighting the key activities
in each, and providing object lessons about
where companies often go astray.
2018 to Apr 2019.
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mailto:[email protected]

Research in Nursing & Health, 2011, 34, 169–170
EDITORIAL
IOM Report, The Future of Nursing: Leading Change,
Advancing Health:
Milestones and Challenges in Expanding Nursing Science
The Institute ofMedicine’s (IOM, 2011) report,
The Future of Nursing: Leading Change, Advan-
cing Health, was released October 5, 2010. The
report represents a significant milestone for health
care, demonstrating the depth, breadth, and
sophistication of nursing science. Nursing’s col-
lective body of work withstood the rigors of
independent IOM reviewers. The Future of Nur-
sing recommendations, like those in all IOM
reports, reflect an evidence-based context, and
they set forth evidence-based directions for how
nursing and nursing research can best serve the
public. Research in Nursing &Health (RINAH) is
one example of an important scientific dissemina-
tion channel.
The report creates a sense of urgency about the
future of nursing research. Recommendation 4,
which calls for increasing the proportion of nurses
with baccalaureate degrees, directly ties to
recommendation 5, to double the number of
nurses with doctorates by 2020. Simply put, the
pool of nurses with the capacity to conduct inquiry
and research will be insufficient unless a pipeline
of nurses advance to an academic level where they
can pursue advanced studies. Not only will
research suffer, academe and service also need
highly educated nurses to teach and lead. Recom-

mendation 8 calls for strengthening the collection
and analysis of workforce data. This is a key
mandate for PhD-prepared nurses to use their
considerable skills beyond the clinical research
questions in which they have traditionally
engaged.
Nurses educated as researchers and scientists
must value, relate to, and interact with nurses who
possess other types of doctoral or master’s
education, including those with practice doctor-
ates. Although master’s and doctorally prepared
clinical scholars do not have the benefit of formal
education in advanced research methods and
statistical techniques, they are nonetheless critical
to clinical inquiry at the point-of-care and
evidence-driven decision making within the
organizational context. Their clinical expertise
and advanced knowledge of nursing practice can
be used in partnership with nurse scientists. As
knowledge expands and is publically accessible,
the public demand for interpretation and immedi-
ate application of scientific findings in clinical
settings is increasing. Inter- and intra-professional
connectivity will optimize nursing’s impact in
advancing health via the synergy that bridges
scientific knowledge generation with translational
expertise at the point of care. This synergy may
also serve to link nursing better with other health
care professions, giving nurses a stronger voice in
decision-making forums and at policy tables.
Chapter 7 of the IOM report, ‘‘Recommenda-
tions andResearch Priorities,’’merits the attention
of the nursing scientific community. Many nurse

scientists and researchers have a dedicated focus
on clinical research, which is still much needed in
light of concerns for quality, safety, aging,
chronicity, and other clinical concerns. In contrast,
the priorities identified in chapter 7 reflect a
research agenda expanded to less studied areas of
transforming nursing practice models, enhancing
nursing education, and influencing nursing leader-
ship. As a member of the committee developing
this report I recognized the importance of these
subject areas as essential to the application of
clinical research. For example, if nursing practice
environments are needlessly complicated, then
the implementation of clinical research findings
will be stymied. If we have insufficient knowledge
about pedagogical strategies that enhance learn-
ing, then we waste critical resources in the
education of learners who comprise our research
pipeline. If we fail to examine the complexities of
leadership and their impact on patient care, health
systems, and education, then our science is not
valued and our input is not felt in settings where
nursing should be at the table. If we can accept this
broader research portfolio—and I suggest it is
Correspondence to Michael R. Bleich
*Dean and Dr. Carol A. Lindeman Distinguished Professor;
Vice Provost—
Interprofessional Education.
Published online 22 April 2011 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/nur.20433
�2011 Wiley Periodicals, Inc.

imperative to do so—then we can attract nurses
who have these interests. We do not need to do this
alone. With the next generation of nurse scientists
we can work in interprofessional teams with
organizational, complexity, informatics, and sys-
tems scientists.
This is a time for action. The Robert Wood
Johnson Foundation (RWJF), whose leadership
and funding engaged the IOM in examining the
future of nursing, made the commitment to
develop a national implementation strategy for
the recommendations. It is known as the Cam-
paign for Action. At RWJF Dr. Susan Hassmiller,
Senior Advisor for Nursing; Dr. Lori Melichar,
Senior Economist; and Christine Phares, Grants
Administrator have put forth a national research
agenda that integrates the prioritized research
questions in the report with additional contribu-
tions from policy makers and nursing experts.
As part of the implementation campaign, an
innovative funding model, the Nurse Funders’
Network, has been announced. This creative
model is a clearinghouse that will match research-
ers with interested donors. The RWJF hopes to
leverage the contributions of smaller foundations
or individuals who lack a research review
mechanism. With assurance, these funders will
now be able to place their contributions through
the clearinghouse, concurrently supporting
research topics that advance the IOM recommen-
dations. Dr. Lori Melichar described the funding
goals as iterative and evolving as the results of

studies are shared rapidly with policy-makers and
other stakeholders.
Researchers should note that the inaugural Call
for Proposal is under way. Submissions will be
reviewed competitively for relevance and rigor
within the Network, and then the best will be
announced to funders for their selection and
awards.
The Call for Proposals will solicit for a range of
research projects from quick studies and scans,
policy analyses, secondary data analyses, descrip-
tive and case studies, to demonstrations with
program evaluation and theoretical modeling. The
research questions will vary too, from ‘‘Is there
a value proposition for health plans using APRNS
in panels?’’ to ‘‘How effective are various inter-
professional education models?’’ to ‘‘What
competencies are most important for contempor-
ary nursing care?’’ to ‘‘What new technologies
support nurse decision-making and care
delivery?’’
It is time to ask who will be the next generation
of nurse researchers to tackle research to advance
quality and safety, nursing education, care deliv-
ery, and workforce issues? Let me be direct.When
Linda Aiken, Patricia Benner, Peter Buerhaus,
Christine Kovner, Mary Naylor, Christine Tanner,
and other pioneer organizational, educational,
policy, and workforce scientists sunset their
careers will the next generation of researchers be
ready to step up? Each of these pioneers has been a
tenacious leader, scientist, and mentor, but they

have had to carry forward their work, often with
funding challenges and against many odds.
Does the nursing and nursing science commu-
nity have the collective desire to advance the
breadth and depth of research, extending the
achievements reflected in the IOM report? This is
a time for bold leadership from the research
community. Like many others, I know that we
have the collective talent, skills, and abilities to
wisely chart a broader research agenda for nursing
and the needs of the public.
Michael R. Bleich*
School of Nursing
Oregon Health & Science University
3455 SW US Veterans Hospital Road
Portland, Oregon 97239
REFERENCE
Institute of Medicine. (2011). The future of nursing:
Leading change, advancing health. Washington, DC:
The National Academies Press.
Research in Nursing & Health
170 RESEARCH INNURSING&HEALTH

1
The Essentials of Doctoral Education
for Advanced Nursing Practice
October 2006
TABLE OF CONTENTS
Page
Introduction
Background 3
Comparison Between Research-Focused and Practice-Focused
Doctoral Education 3
AACN Task Force on the Practice Doctorate in Nursing 4
Context of Graduate Education in Nursing 5
Relationships of Master’s, Practice Doctorate, and Research
Doctorate Programs 6
DNP Graduates and Academic Roles 7
The Essentials of Doctoral Education for Advanced Nursing
Practice 8
I. Scientific Underpinnings for Practice 8
II. Organizational and Systems Leadership for Quality
Improvement and Systems Thinking 9
III. Clinical Scholarship and Analytical Methods
for Evidence-Based Practice 11

IV. Information Systems/Technology and Patient Care
Technology
for the Improvement and Transformation of Health Care 12
V. Health Care Policy for Advocacy in Health Care 13
VI. Interprofessional Collaboration for Improving Patient
and Population Health Outcomes 14
VII. Clinical Prevention and Population Health for Improving
the Nation’s Health 15
VIII. Advanced Nursing Practice 16
Incorporation of Specialty-Focused Competencies into DNP
Curricula 17
Advanced Practice Nursing Focus 17
Aggregate/Systems/Organizational Focus 18
A DVAN CIN G HI GH ER ED UCA T IO N IN NU RSI NG
One Dupont Circle NW, Suite 530 · Washington, DC 20036 ·
202-463-6930 tel · 202-785-8320 fax · www.aacn.nche.edu
2
Curricular Elements and Structure 18
Program Length 18
Practice Experiences in the Curriculum 19
Final DNP Project 19

DNP Programs in the Academic Environment: Indicators of
Quality
in Doctor of Nursing Practice Programs 20
Faculty Characteristics 20
The Faculty and Practice 20
Practice Resources and Clinical Environment Resources 21
Academic Infrastructure 21
Appendix A
Advanced Health/Physical Assessment 23
Advanced Physiology and Pathophysiology 23
Advanced Pharmacology 24
Appendix B
DNP Essentials Task Force 25
References 27
3
Introduction
Background
Doctoral programs in nursing fall into two principal types:
research-focused and practice-
focused. Most research-focused programs grant the Doctor of

Philosophy degree (PhD),
while a small percentage offers the Doctor of Nursing Science
degree (DNS, DSN, or
DNSc). Designed to prepare nurse scientists and scholars, these
programs focus heavily
on scientific content and research methodology; and all require
an original research
project and the completion and defense of a dissertation or
linked research papers.
Practice-focused doctoral programs are designed to prepare
experts in specialized
advanced nursing practice. They focus heavily on practice that
is innovative and
evidence-based, reflecting the application of credible research
findings. The two types of
doctoral programs differ in their goals and the competencies of
their graduates. They
represent complementary, alternative approaches to the highest
level of educational
preparation in nursing.
The concept of a practice doctorate in nursing is not new.
However, this course of study
has evolved considerably over the 20 years since the first
practice-focused nursing
doctorate, the Doctor of Nursing (ND), was initiated as an
entry-level degree. Because
research- and practice-focused programs are distinctly different,
the current position of
the American Association of Colleges of Nursing (AACN, 2004)
[detailed in the Position
Statement on the Practice Doctorate in Nursing] is that: “The
two types of doctorates,
research-focused and practice-focused, may coexist within the
same education unit” and
that the practice-focused degree should be the Doctor of

Nursing Practice (DNP).
Recognizing the need for consistency in the degrees required for
advanced nursing
practice, all existing ND programs have transitioned to the
DNP.
Comparison Between Research-Focused and Practice-Focused
Doctoral Education
Research- and practice-focused doctoral programs in nursing
share rigorous and
demanding expectations: a scholarly approach to the discipline,
and a commitment to the
advancement of the profession. Both are terminal degrees in the
discipline, one in
practice and one in research. However, there are distinct
differences between the two
degree programs. For example, practice-focused programs
understandably place greater
emphasis on practice, and less emphasis on theory, meta-theory,
research methodology,
and statistics than is apparent in research-focused programs.
Whereas all research-
focused programs require an extensive research study that is
reported in a dissertation or
through the development of linked research papers, practice-
focused doctoral programs
generally include integrative practice experiences and an
intense practice immersion
experience. Rather than a knowledge-generating research
effort, the student in a practice-
focused program generally carries out a practice application-
oriented “final DNP
project,” which is an integral part of the integrative practice
experience.

4
AACN Task Force on the Practice Doctorate in Nursing
The AACN Task Force to Revise Quality Indicators for
Doctoral Education found that
the Indicators of Quality in Research-Focused Doctoral
Programs in Nursing are
applicable to doctoral programs leading to a PhD or a DNS
degree (AACN, 2001b, p. 1).
Therefore, practice-focused doctoral programs will need to be
examined separately from
research-focused programs. This finding coupled with the
growing interest in practice
doctorates prompted the establishment of the AACN Task Force
on the Practice
Doctorate in Nursing in 2002. This task force was convened to
examine trends in
practice-focused doctoral education and make recommendations
about the need for and
nature of such programs in nursing. Task force members
included representatives from
universities that already offered or were planning to offer the
practice doctorate, from
universities that offered only the research doctorate in nursing,
from a specialty
professional organization, and from nursing service
administration. The task force was
charged to describe patterns in existing practice-focused
doctoral programs; clarify the
purpose of the practice doctorate, particularly as differentiated

from the research
doctorate; identify preferred goals, titles, and tracks; and
identify and make
recommendations about key issues. Over a two-year period, this
task force adopted an
inclusive approach that included: 1) securing information from
multiple sources about
existing programs, trends and potential benefits of a practice
doctorate; 2) providing
multiple opportunities for open discussion of related issues at
AACN and other
professional meetings; and 3) subjecting draft recommendations
to discussion and input
from multiple stakeholder groups. The final position statement
was approved by the
AACN Board of Directors in March 2004 and subsequently
adopted by the membership.
The 2004 DNP position statement calls for a transformational
change in the education
required for professional nurses who will practice at the most
advanced level of nursing.
The recommendation that nurses practicing at the highest level
should receive doctoral
level preparation emerged from multiple factors including the
expansion of scientific
knowledge required for safe nursing practice and growing
concerns regarding the quality
of patient care delivery and outcomes. Practice demands
associated with an increasingly
complex health care system created a mandate for reassessing
the education for clinical
practice for all health professionals, including nurses.
A significant component of the work by the task force that
developed the 2004 position

statement was the development of a definition that described the
scope of advanced
nursing practice. Advanced nursing practice is broadly defined
by AACN (2004) as:
any form of nursing intervention that influences health care
outcomes for
individuals or populations, including the direct care of
individual patients,
management of care for individuals and populations,
administration of
nursing and health care organizations, and the development and
implementation of health policy. (p. 2)
5
Furthermore, the DNP position statement (AACN, 2004, p. 4)
identifies the benefits of
practice focused doctoral programs as:
• development of needed advanced competencies for
increasingly complex practice,
faculty, and leadership roles;
• enhanced knowledge to improve nursing practice and patient
outcomes;
• enhanced leadership skills to strengthen practice and health
care delivery;
• better match of program requirements and credits and time
with the credential

earned;
• provision of an advanced educational credential for those who
require advanced
practice knowledge but do not need or want a strong research
focus (e.g., practice
faculty);
• enhanced ability to attract individuals to nursing from non-
nursing backgrounds;
and
• increased supply of faculty for practice instruction.
As a result of the membership vote to adopt the recommendation
that the nursing
profession establish the DNP as its highest practice degree, the
AACN Board of
Directors, in January 2005, created the Task Force on the
Essentials of Nursing
Education for the Doctorate of Nursing Practice and charged
this task force with
development of the curricular expectations that will guide and
shape DNP education.
The DNP Essentials Task Force is comprised of individuals
representing multiple
constituencies in advanced nursing practice (see Appendix B).
The task force conducted
regional hearings from September 2005 to January 2006 to
provide opportunities for
feedback from a diverse group of stakeholders. These hearings
were designed using an
iterative process to develop this document. In total, 620
participants representing 231
educational institutions and a wide variety of professional

organizations participated in
the regional meetings. Additionally, a national stakeholders’
conference was held in
October 2005 in which 65 leaders from 45 professional
organizations participated.
Context of Graduate Education in Nursing
Graduate education in nursing occurs within the context of
societal demands and needs as
well as the interprofessional work environment. The Institute
of Medicine (IOM, 2003)
and the National Research Council of the National Academies
(2005, p. 74) have called
for nursing education that prepares individuals for practice with
interdisciplinary,
information systems, quality improvement, and patient safety
expertise.
In hallmark reports, the IOM (1999, 2001, 2003) has focused
attention on the state of
health care delivery, patient safety issues, health professions
education, and leadership for
nursing practice. These reports highlight the human errors and
financial burden caused
by fragmentation and system failures in health care. In
addition, the IOM calls for
dramatic restructuring of all health professionals’ education.
Among the
recommendations resulting from these reports are that health
care organizations and
6

groups promote health care that is safe, effective, client-
centered, timely, efficient, and
equitable; that health professionals should be educated to
deliver patient-centered care as
members of an interdisciplinary team, emphasizing evidence-
based practice, quality
improvement, and informatics; and, that the best prepared
senior level nurses should be in
key leadership positions and participating in executive
decisions.
Since AACN published The Essentials of Master’s Education
for Advanced Practice
Nursing in 1996 and the first set of indicators for quality
doctoral nursing education in
1986, several trends in health professional education and health
care delivery have
emerged. Over the past two decades, graduate programs in
nursing have expanded from
220 institutions offering 39 doctoral programs and 180 master’s
programs in 1986 to 518
institutions offering 101 doctoral programs and 417 master’s
programs in 2006.
Increasing numbers of these programs offer preparation for
certification in advanced
practice specialty roles such as nurse practitioners, nurse
midwives, nurse anesthetists,
and clinical nurse specialists. Specialization is also a trend in
other health professional
education. During this same time period, the explosion in
information, technology, and
new scientific evidence to guide practice has extended the
length of educational programs
in nursing and the other health professions. In response to these
trends, several other

health professions such as pharmacy, physical therapy,
occupational therapy, and
audiology have moved to the professional or practice doctorate
for entry into these
respective professions.
Further, support for doctoral education for nursing practice was
found in a review of
current master’s level nursing programs (AACN, 2004, p. 4).
This review indicated that
many programs already have expanded significantly in response
to the above concerns,
creating curricula that exceed the usual credit load and duration
for a typical master’s
degree. The expansion of credit requirements in these programs
beyond the norm for a
master’s degree raises additional concerns that professional
nurse graduates are not
receiving the appropriate degree for a very complex and
demanding academic experience.
Many of these programs, in reality, require a program of study
closer to the curricular
expectations for other professional doctoral programs rather
than for master’s level study.
Relationships of Master’s, Practice Doctorate, and Research
Doctorate Programs
The master’s degree (MSN) historically has been the degree for
specialized advanced
nursing practice. With development of DNP programs, this
new degree will become the
preferred preparation for specialty nursing practice. As
educational institutions transition
from the master’s to DNP degree for advanced practice

specialty preparation, a variety of
program articulations and pathways are planned. One constant
is true for all of these
models. The DNP is a graduate degree and is built upon the
generalist foundation
acquired through a baccalaureate or advanced generalist
master’s in nursing. The
Essentials of Baccalaureate Education (AACN, 1998)
summarizes the core knowledge
and competencies of the baccalaureate prepared nurse. Building
on this foundation, the
DNP core competencies establish a base for advanced nursing
practice in an area of
specialization. Ultimately, the terminal degree options in
nursing will fall into two
7
primary education pathways: professional entry degree
(baccalaureate or master’s) to
DNP degree or professional entry degree (baccalaureate or
master’s) to PhD degree. As
in other disciplines with practice doctorates, some individuals
may choose to combine a
DNP with a PhD.
Regardless of the entry point, DNP curricula are designed so
that all students attain DNP
end-of-program competencies. Because different entry points
exist, the curricula must be
individualized for candidates based on their prior education and
experience. For
example, early in the transition period, many students entering
DNP programs will have a

master’s degree that has been built on AACN’s Master’s
Essentials. Graduates of such
programs would already have attained many of the competencies
defined in the DNP
Essentials. Therefore, their program will be designed to
provide those DNP
competencies not previously attained. If a candidate is entering
the program with a non-
nursing baccalaureate degree, his/her program of study likely
will be longer than a
candidate entering the program with a baccalaureate or master’s
in nursing. While
specialty advanced nursing education will be provided at the
doctoral level in DNP
programs, new options for advanced generalist master’s
education are being developed.
DNP Graduates and Academic Roles
Nursing as a practice profession requires both practice experts
and nurse scientists to
expand the scientific basis for patient care. Doctoral education
in nursing is designed to
prepare nurses for the highest level of leadership in practice and
scientific inquiry. The
DNP is a degree designed specifically to prepare individuals for
specialized nursing
practice, and The Essentials of Doctoral Education for
Advanced Nursing Practice
articulates the competencies for all nurses practicing at this
level.
In some instances, individuals who acquire the DNP will seek to
fill roles as educators
and will use their considerable practice expertise to educate the

next generation of nurses.
As in other disciplines (e.g., engineering, business, law), the
major focus of the
educational program must be on the area of practice
specialization within the discipline,
not the process of teaching. However, individuals who desire a
role as an educator,
whether that role is operationalized in a practice environment or
the academy, should
have additional preparation in the science of pedagogy to
augment their ability to
transmit the science of the profession they practice and teach.
This additional preparation
may occur in formal course work during the DNP program.
Some teaching strategies and learning principles will be
incorporated into the DNP
curriculum as it relates to patient education. However, the
basic DNP curriculum does
not prepare the graduate for a faculty teaching role any more
than the PhD curriculum
does. Graduates of either program planning a faculty career will
need preparation in
teaching methodologies, curriculum design and development,
and program evaluation.
This preparation is in addition to that required for their area of
specialized nursing
practice or research in the case of the PhD graduate.
8
The Essentials of Doctoral Education for Advanced Nursing

Practice
The following DNP Essentials outline the curricular elements
and competencies that
must be present in programs conferring the Doctor of Nursing
Practice degree. The DNP
is a degree title, like the PhD or MSN, and does not designate in
what specialty a
graduate is prepared. DNP graduates will be prepared for a
variety of nursing practice
roles. The DNP Essentials delineated here address the
foundational competencies that are
core to all advanced nursing practice roles. However, the depth
and focus of the core
competencies will vary based on the particular role for which
the student is preparing.
For example, students preparing for organizational leadership or
administrative roles will
have increased depth in organizational and systems’ leadership;
those preparing for
policy roles will have increased depth in health care policy; and
those preparing for APN
roles (nurse practitioners, clinical nurse specialists, nurse
anesthetists, and nurse
midwives) will have more specialized content in an area of
advanced practice nursing.
Additionally, it is important to understand that the delineation
of these competencies
should not be interpreted to mean that a separate course for each
of the DNP Essentials
should be offered. Curricula will differ in emphases based on
the particular specialties
for which students are being prepared.

The DNP curriculum is conceptualized as having two
components:
1. DNP Essentials 1 through 8 are the foundational outcome
competencies deemed
essential for all graduates of a DNP program regardless of
specialty or functional
focus.
2. Specialty competencies/content prepare the DNP graduate
for those practice and
didactic learning experiences for a particular specialty.
Competencies, content,
and practica experiences needed for specific roles in specialty
areas are
delineated by national specialty nursing organizations.
The DNP Essentials document outlines and defines the eight
foundational Essentials and
provides some introductory comments on specialty
competencies/content. The
specialized content, as defined by specialty organizations,
complements the areas of core
content defined by the DNP Essentials and constitutes the major
component of DNP
programs. DNP curricula should include these two components
as appropriate to the
specific advanced nursing practice specialist being prepared.
Additionally, the faculty of
each DNP program has the academic freedom to create
innovative and integrated
curricula to meet the competencies outlined in the Essentials

document.
Essential I: Scientific Underpinnings for Practice
The practice doctorate in nursing provides the terminal
academic preparation for nursing
practice. The scientific underpinnings of this education reflect
the complexity of practice
9
at the doctoral level and the rich heritage that is the conceptual
foundation of nursing.
The discipline of nursing is focused on:
• The principles and laws that govern the life-process, well-
being, and optimal
function of human beings, sick or well;
• The patterning of human behavior in interaction with the
environment in normal
life events and critical life situations;
• The nursing actions or processes by which positive changes in
health status are
affected; and
• The wholeness or health of human beings recognizing that
they are in continuous
interaction with their environments (Donaldson & Crowley,
1978; Fawcett, 2005;
Gortner, 1980).

DNP graduates possess a wide array of knowledge gleaned from
the sciences and have
the ability to translate that knowledge quickly and effectively to
benefit patients in the
daily demands of practice environments (Porter-O’Grady,
2003). Preparation to address
current and future practice issues requires a strong scientific
foundation for practice. The
scientific foundation of nursing practice has expanded and
includes a focus on both the
natural and social sciences. These sciences that provide a
foundation for nursing practice
include human biology, genomics, the science of therapeutics,
the psychosocial sciences,
as well as the science of complex organizational structures. In
addition, philosophical,
ethical, and historical issues inherent in the development of
science create a context for
the application of the natural and social sciences. Nursing
science also has created a
significant body of knowledge to guide nursing practice and has
expanded the scientific
underpinnings of the discipline. Nursing science frames the
development of middle
range theories and concepts to guide nursing practice. Advances
in the foundational and
nursing sciences will occur continuously and nursing curricula
must remain sensitive to
emerging and new scientific findings to prepare the DNP for
evolving practice realities.
The DNP program prepares the graduate to:
1. Integrate nursing science with knowledge from ethics, the
biophysical,

psychosocial, analytical, and organizational sciences as the
basis for the highest
level of nursing practice.
2. Use science-based theories and concepts to:
• determine the nature and significance of health and health care
delivery
phenomena;
• describe the actions and advanced strategies to enhance,
alleviate, and
ameliorate health and health care delivery phenomena as
appropriate; and
• evaluate outcomes.
3. Develop and evaluate new practice approaches based on
nursing theories and
theories from other disciplines.
10
Essential II: Organizational and Systems Leadership for Quality
Improvement and
Systems Thinking
Organizational and systems leadership are critical for DNP
graduates to improve patient
and healthcare outcomes. Doctoral level knowledge and skills
in these areas are
consistent with nursing and health care goals to eliminate health

disparities and to
promote patient safety and excellence in practice.
DNP graduates’ practice includes not only direct care but also a
focus on the needs of a
panel of patients, a target population, a set of populations, or a
broad community. These
graduates are distinguished by their abilities to conceptualize
new care delivery models
that are based in contemporary nursing science and that are
feasible within current
organizational, political, cultural, and economic perspectives.
Graduates must be skilled in working within organizational and
policy arenas and in the
actual provision of patient care by themselves and/or others.
For example, DNP
graduates must understand principles of practice management,
including conceptual and
practical strategies for balancing productivity with quality of
care. They must be able to
assess the impact of practice policies and procedures on meeting
the health needs of the
patient populations with whom they practice. DNP graduates
must be proficient in
quality improvement strategies and in creating and sustaining
changes at the
organizational and policy levels. Improvements in practice are
neither sustainable nor
measurable without corresponding changes in organizational
arrangements,
organizational and professional culture, and the financial
structures to support practice.
DNP graduates have the ability to evaluate the cost
effectiveness of care and use
principles of economics and finance to redesign effective and

realistic care delivery
strategies. In addition, DNP graduates have the ability to
organize care to address
emerging practice problems and the ethical dilemmas that
emerge as new diagnostic and
therapeutic technologies evolve. Accordingly, DNP graduates
are able to assess risk and
collaborate with others to manage risks ethically, based on
professional standards.
Thus, advanced nursing practice includes an organizational and
systems leadership
component that emphasizes practice, ongoing improvement of
health outcomes, and
ensuring patient safety. In each case, nurses should be prepared
with sophisticated
expertise in assessing organizations, identifying systems’
issues, and facilitating
organization-wide changes in practice delivery. In addition,
advanced nursing practice
requires political skills, systems thinking, and the business and
financial acumen needed
for the analysis of practice quality and costs.
The DNP program prepares the graduate to:
1. Develop and evaluate care delivery approaches that meet
current and future needs of
patient populations based on scientific findings in nursing and
other clinical sciences,
as well as organizational, political, and economic sciences.
2. Ensure accountability for quality of health care and patient
safety for populations with
whom they work.

11
a. Use advanced communication skills/processes to lead quality
improvement
and patient safety initiatives in health care systems.
b. Employ principles of business, finance, economics, and
health policy to
develop and implement effective plans for practice-level and/or
system-wide
practice initiatives that will improve the quality of care
delivery.
c. Develop and/or monitor budgets for practice initiatives.
d. Analyze the cost-effectiveness of practice initiatives
accounting for risk and
improvement of health care outcomes.
e. Demonstrate sensitivity to diverse organizational cultures and
populations,
including patients and providers.
3. Develop and/or evaluate effective strategies for managing the
ethical dilemmas
inherent in patient care, the health care organization, and
research.
Essential III: Clinical Scholarship and Analytical Methods for
Evidence-Based
Practice

Scholarship and research are the hallmarks of doctoral
education. Although basic
research has been viewed as the first and most essential form of
scholarly activity, an
enlarged perspective of scholarship has emerged through
alternative paradigms that
involve more than discovery of new knowledge (Boyer, 1990).
These paradigms
recognize that (1) the scholarship of discovery and integration
“reflects the investigative
and synthesizing traditions of academic life” (Boyer, p. 21); (2)
scholars give meaning to
isolated facts and make connections across disciplines through
the scholarship of
integration; and (3) the scholar applies knowledge to solve a
problem via the scholarship
of application (referred to as the scholarship of practice in
nursing). This application
involves the translation of research into practice and the
dissemination and integration of
new knowledge, which are key activities of DNP graduates.
The scholarship of
application expands the realm of knowledge beyond mere
discovery and directs it toward
humane ends. Nursing practice epitomizes the scholarship of
application through its
position where the sciences, human caring, and human needs
meet and new
understandings emerge.
Nurses have long recognized that scholarly nursing practice is
characterized by the
discovery of new phenomena and the application of new
discoveries in increasingly
complex practice situations. The integration of knowledge from
diverse sources and

Writing Measurable Learning Outcomes Sandi Osters, Di.docx

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