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Yale School of Nursing

History

The School of Nursing, founded in 1923, became the first school to prepare nurses under an educational rather than an apprenticeship program. Dean Annie Goodrich’s insistence that her students came to Yale to learn a highly skilled profession rather than to provide extra hands to already trained nurses was truly revolutionary. The School has continued to spawn new ideas that have helped redefine nursing: the groundbreaking research of Virginia Henderson, the founding of the American hospice movement, and the first “graduate entry” system that enlivened nursing practice by attracting mature students with varied and rich life experiences.

Since its founding, the School routinely revises its curriculum to meet the profession’s needs. Because of an increasing realization that a college education was essential in the profession of nursing, the School of Nursing admitted only college graduates after 1934. Fifteen years later an advanced program in mental health nursing was added to the basic program. In 1952 the School became coeducational when the first male student was admitted.

A study of nursing education at Yale was undertaken in 1952. The Yale Corporation decided that the University could contribute to nursing most effectively through a graduate program for nurses who had both basic professional preparation and a baccalaureate degree. The basic program was discontinued in 1956, and the curriculum of the advanced program was expanded to prepare nurses in psychiatric–mental health, maternal-newborn health, and community health nursing. Nurse-midwifery was an option in the Maternal-Newborn Health Program until 1972, when it became the total clinical component of the program. A Master of Science in Nursing degree was awarded to those who had successfully completed a minimum of one year’s study, coupled with a summer field experience. A Certificate in Nurse-Midwifery was also awarded by Yale University until 1972, when national certification by the American College of Nurse-Midwives was instituted.

In 1959–60 a revised curriculum of two years of study leading to the master’s degree was inaugurated. The curriculum was further expanded in 1969 to include pediatric nursing and in 1974 to include medical-surgical nursing. In September 1992 a specialty was added in nursing systems and policy, then renamed nursing management and policy. That specialty was discontinued in 2003. In 2006 Nursing Management, Policy, and Leadership was added to prepare leaders in the management of delivery systems that promote patient safety and quality of care. In April 1997 the Yale Corporation approved the Post-Master’s Certificate for advanced practice nurses seeking additional specialty preparation. The first Post-Master’s Certificates were awarded at the May 1997 commencement exercises.

In April 1970 the Corporation approved development of a three-year curriculum for college graduates from other fields, a program of study now known as the Graduate Entry Prespecialty in Nursing. The first class of twelve enrolled in the fall of 1974.

In November 1992 the Corporation approved the development of a Doctor of Nursing Science program. The first class was admitted and enrolled in September 1994; and the first graduates were awarded the D.N.Sc. in June 1998. In 2006 the Corporation approved the program’s conversion from the Doctor of Nursing Science to a Doctor of Philosophy, awarded by the Graduate School of Arts and Sciences. The first Ph.D. class was admitted and enrolled in September 2006. In April 2011 the Corporation approved the development of a Doctor in Nursing Practice program. The first class of D.N.P. students was admitted and enrolled in September 2012.

The School is accredited by the Commission on Collegiate Nursing Education, One Dupont Circle, N.W., Suite 530, Washington DC 20036; telephone, 202.887.6791; Web site, www.aacn.nche.edu. The Graduate Entry Prespecialty in Nursing is approved by the State of Connecticut Board of Examiners for Nursing. The Nurse-Midwifery specialty is accredited by the American College of Nurse-Midwives. The Pediatric Nurse Practitioner specialty is accredited by the Pediatric Nursing Certification Board.

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Mission

The ultimate mission of the Yale School of Nursing is better health for all people. We accomplish this by educating each generation of nurse leaders, scholars, and practitioners; transforming health care practice; and advancing science. Building on the tradition of our founding dean, Annie W. Goodrich, the YSN community relates the “adventure of thought to the adventure of action, in touch with the fundamentals of human experience” across local, national, and international systems of care.

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Values

The Yale School of Nursing is a community that holds an expansive view of health and believes that access to high-quality, patient-centered health care is a social right, not a privilege. In our intellectual and clinical work, we value integrity, dignity, rigor, curiosity, and excellence. Mindful of our traditions, as well as those of Yale University, we emphasize innovation grounded in creativity and the integration of education, scholarship, practice, and policy in service of social justice and health equity. Respect for diversity of thought, ideas, and opinions of others guides all of our work. We value the wise use of resources. We are committed to interprofessional education, research, and practice, and mentorship of the next generation of leaders. We strive to create an environment for study that is caring and supports openness and transparency.

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Philosophy

Each person is a unique biological, psychological, social being, who is influenced by and influences environments. Culture and society shape a person’s values, beliefs, behaviors, and perceptions about health and illness. We believe that individual differences are to be respected, free from bias and stereotyping.

Individuals have the right to accurate and comprehensible information about their health care and available resources. Individuals have the right to participate in decisions concerning their care and their return to health.

Our diverse society is composed of individuals, families, and communities that share a need for health care. We believe in working toward a society in which individuals have equal rights regardless of personal characteristics or genetic differences.

Health is a product of a dynamic process in which growth and development enable adaptation to changing environmental demands. We believe that improvement in health care will be facilitated through the collaborative efforts of patients* and health professionals.

Concern for the highest possible quality of life, respect for human value, and commitment to caring are the primary postulates of nursing. Nursing involves an alliance with the patient to promote health, prevent disease, treat selected illness, and maintain or restore function. Nursing services may be provided independently or in collaboration with other health professionals. Nursing draws upon the integration of science and humanism, and theory developed through practice and research. We believe that the Yale School of Nursing has an obligation to effect public and colleague acceptance of the leadership capabilities of the nursing profession.

Faculty are committed to the advancement of nursing knowledge and the improvement of health care. It is our responsibility to shape the design of health care and nursing education systems, because we believe that improving patient care improves education and, likewise, improving education improves patient care. An environment conducive to an interchange of ideas among students, faculty, and administration is essential. The character of University life for faculty and students consists of active teaching and learning, clinical scholarship, and research upon which to base current and future education and practice.

We believe that practice will be improved through sound clinical judgment, scholarship, and research. Those who enter this environment should exhibit a readiness for systematic inquiry and critical thinking, and the ability to contribute to the advancement of nursing knowledge and health policy.

*The term “patient” encompasses individuals, families, groups, and communities across the life span in various states of health and illness.

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Organizational Framework

Curriculum follows directly from the Yale School of Nursing’s mission and philosophy. The aims and assumptions of the School state:

The master’s curriculum is designed to offer students an opportunity to become prepared as advanced practitioners in selected health care specialties so that they may assume roles as clinicians, scholars, and leaders and ultimately improve health care for all people. Advanced Practice Nurses are committed to the delivery and the study of high-quality, evidence-based clinical care and work to help shape health care systems. The program of study in the School is viewed as preparation for graduates’ continuing activity in a variety of leadership roles.

Advanced Nursing Practice

Nursing involves an alliance with the patient* or health care system using a holistic and contextual perspective. This statement is further substantiated by a direct quote:

…to assist the individual, sick or well, with those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.

—V. Henderson, The Nature of Nursing (Philadelphia: Macmillan, 1963)

Advanced Practice Nursing is defined as specialization in an area of practice and builds upon mastery of depth and breadth of specific knowledge. Practicing at the advanced level also involves the identification of signs/symptoms/behaviors that indicate vulnerability and the selection of interventions to promote health and prevent illness, disability, and complications. Nurses in advanced practice integrate knowledge, scholarship, management, leadership, and consultation into their role and function in collaboration with other members of the health care team.

Knowledge supporting advanced practice nursing is organized into three constructs: clinical practice, scholarship, and leadership.

*The term “patient” encompasses individuals, families, groups, and communities across the life span in various states of health and illness.
Clinical Practice

Clinical practice includes the assessment, management, and coordination of health care needs of individuals, families, groups, communities, and/or populations. This care occurs within bio-psychosocial, cultural, political, environmental, and economic contexts.

Clinical practice requires that clinicians foster, develop, and sustain effective patient-provider relationships within the context of complex organizational and health care delivery systems. Excellent clinical practice is based on current and relevant evidence-based data and entails the systematic collection of diverse forms of information, sound analytical reasoning, strong interpersonal and leadership skills, knowledge of organizational and systems behavior, and proficiency in translating knowledge into practice and policy. The ultimate goal of clinical practice is to enable patients to attain the best possible quality of life by integrating principles of health promotion and disease prevention into their lifestyles and fostering an effective patient-provider relationship. Clinical practice includes clinicians’ ability to coordinate patient care, resources, and services among providers and to provide patients with the information needed to attain optimum health outcomes.

Scholarship

Scholarship forms the underpinning and context for advanced practice nursing. Scholarship encompasses the iterative process of generating and testing theories, applying them in practice settings, and revising theories based on data. This intellectual process involves familiarity with knowledge of current and cutting-edge science from nursing and other health-related disciplines, critical analysis, hypothesis formation and testing, and consideration of alternative theories. In clinical practice, scholarship includes assessment, data gathering, hypothesis generation, and use of clinical data for evaluation.

Scholarship involves systematic evaluation of the rationale for health-related decision making, critical analysis of health-related issues and policies, and the process of describing, explaining, and predicting phenomena of relevance to human health, health care environments, and nursing. Examples of relevant phenomena include, but are not limited to, patterns of human behavior and the contexts in which it occurs, physiological and pathophysiological processes, and health care systems, ethical concerns, and policy. Knowledge is generated through empirical, aesthetic, personal, and ethical ways of knowing. Ongoing critical evaluation of the state of the science and questioning of available information, as well as personal clinical wisdom, are critical components of scholarly inquiry.

Scholarly activity is the hallmark of graduate education in nursing and provides the basis for delivery of evidence-based best nursing practices. Scholarship is an essential organizing construct for the curriculum and is evident in the strong emphasis on using empirical, personal, aesthetic, and ethical knowledge. Development of scholarly skills and use of knowledge derived from these skills are addressed in clinical and didactic courses.

Leadership

Leadership is essential for creating change within a society, organization, or health care system. Ultimately, leadership is about the capacity for vision and the wise use of power, authority, managerial skills, and influence to enable others to accomplish and sustain change. Change is an important concept based in knowledge of group process, organizational and systems theory, and leadership strategies. Influence comes in part from knowledge of the health care system’s structure and process, inter- and intra-professional issues, and public and private sector policies as they affect health care services. Influence also arises from interpersonal competence and knowledge of human relations theories. Leadership is necessary at all levels of the health care organization, including at the level of patient care, where it is seen in autonomy and accountability of practice, grounded in specialized practice knowledge. Leadership is fundamental to providing equitable health care for all people.

Thus, the three major constructs—clinical practice, scholarly inquiry, and leadership—reinforce each other, true to the nature of knowledge in advanced nursing practice, and provide the organizing framework for the master’s objectives and outcomes.

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Master’s-Level Outcomes

Upon completion of the Master of Science in Nursing Program, graduates will have the requisite skills and knowledge to accomplish the following:

Clinical Practice

  • 1. Provide evidence-based care integrating holistic perspectives and ethical factors at the advanced practice level specific to the specialty area.
  • • Employ appropriate methods/strategies/technologies to gather relevant data from multiple sources.
  • • Analyze and synthesize data to identify and prioritize problems.
  • • Develop and implement management plans using best available evidence, and evaluate outcomes and modify management plans.
  • 2. Engage in scholarship.
  • 3. Critically evaluate clinical evidence from multiple sources (such as current literature, clinical, and patient) to derive implications for best practices.
  • 4. Identify clinical challenges and gaps in knowledge, and participate in scholarship to improve health care.
  • 5. Apply clinical scholarship to improve outcomes in health care.

Scholarship

  • 1. Engage in scholarship.
  • 2. Critically evaluate clinical evidence from multiple sources (such as current literature, clinical, and patient) to derive implications for best practices.
  • 3. Identify clinical challenges and gaps in knowledge, and participate in scholarship to improve health care.
  • 4. Apply clinical scholarship to improve outcomes in health care.

Leadership

  • 1. Provide professional advanced practice nursing/midwifery leadership to improve patient outcomes and shape health care systems.
  • 2. Demonstrate professionalism and integrity in interactions with patients, colleagues, and systems.
  • 3. Collaborate with colleagues and patients to improve access to and quality of health care.
  • 4. Act as a catalyst for assuring access to timely, quality health care for all people irrespective of race, ethnicity, gender, or social status.

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