Despite the increasing demand for nurses to understand and apply genetics in their research, clinical practice, and teaching, most nursing doctoral programs (PhD, DNP) do not offer education or training in the fundamentals of genome science, clinical genomics, or their social and ethical implications.1 The National Human Genome Research Institute (NHGRI) seeks to foster a qualified and diverse biomedical workforce in order to advance science and improve human health. In this article, we describe an NHGRI-funded, self-paced, free online course designed to improve nurses' literacy in genetics and genomics. We also describe our efforts to support inclusivity in the course, which is open to all doctoral-level nurses, faculty, and students.
Need for Genomic Education for Doctoral-Level Nurses
A limited number of nursing doctoral programs include content on genomics, which may be due to crowded curricula, a lack of faculty expertise, or other factors. Once doctoral students graduate, it can be challenging for them to learn or keep current with the rapidly evolving field of genomics. An integrative review found that nurses believe genetics to be relevant, yet they possess little genomic knowledge or core genomic competencies, with minimal evidence of progress over a 5-year period.2 It is encouraging that nurses indicated that they were willing to pursue additional educational opportunities on their own time or at conferences. Indeed, by maximizing the genomic education of doctoral-level nurses today, the knowledge will transmit to future generations of nurse scientists.
Recognizing this area of need, we reviewed current educational offerings for health care providers. Online courses have the flexibility to allow doctoral-level nurses, faculty, and students to learn on their own time and at their own pace, and increase accessibility for individuals who live in remote areas. However, most courses involve a cost to the participant and have a specific content focus (eg, pharmacogenomics). In addition, most offer broad information to a wide audience, or a specialized information to a nonnursing audience (eg, genetic counselors). Therefore, to address these gaps we designed a no cost, self-paced online course tailored to a diverse audience of doctoral-level nurses.
A Novel Approach to Genomic Education for Doctoral-Level Nurses
Our approach to maximizing research education in genomics is based on the premise that increasing opportunities for all doctoral-level nurses, faculty, and students, with a special focus on diversity and inclusion, will carry widespread benefits for both the nursing workforce and the patients they serve. To promote inclusive recruitment, various nursing organizations offered support and expressed interest in participating with this course: Chi Eta Phi Sorority, Inc; International Society of Nurses in Genetics (ISONG); National Association of Hispanic Nurses; National Organization of Nurses with Disabilities; Philippine Nurses Association of America, Inc; and Transcultural Nursing Society.
Overview of the Online Course
The online course, Genomic Competencies for Nurses from Theory to Application, has the following aims: (1) increase literacy in genomics among doctoral-level nurses and faculty to improve the delivery of health care in the era of genomic medicine; (2) provide a foundational introduction to the genetic basis of disease, health risk assessment, epigenetics, and personalized health care with an emphasis on the associated ethical implications of genetic and genomic advancements; (3) identify opportunities for doctoral-level nurses and nursing faculty to apply genomic medicine into research, teaching, and clinical practice; and (4) prepare doctoral-level nurses and faculty to assimilate state-of-the-science genetics and related ethical issues into their research, teaching, and clinical practice with a focus on patients from underrepresented groups.
The online course, delivered asynchronously and with enrollment twice per year, encourages participants to complete the course within 6 to 12 weeks at a pace of 3 hours per week. The pedagogical program design leverages scaffolding of content, supports meaningful engagement, and maximizes the desired learning outcomes most effectively. We are also providing nursing contact hours, thus helping satisfy continuing education professional requirements.
The self-paced online course begins with a primer module on the basics of genetics and genomics. This module is optional but helps tailor learning for those participants who may not have a recent background in the basics of genetics. Six subsequent and required modules are based on the Essential Genetic and Genomic Competencies for Nurses With Graduate Degrees.3 These competencies were developed and validated using a consensus model that involved 31 nursing leaders and genetic experts who represented professional nursing organizations, academic institutions, regulatory bodies, and government agencies. These competencies create the foundation for course-learning objectives and outcomes. The course modules are listed in the Table.
Module 0: Genetic primer (optional)
Module 1: Risk assessment and interpretation
Module 2: Genetic education, counseling, testing and results interpretation
Module 3: Clinical management
Module 4: Ethical, legal, and social implications
Module 5: Research—translation to practice
Module 6: Professional role and leadership
The modules consist of a variety of evidence-based online learning modalities that include prerecorded lectures, cases studies, and video recordings, along with various interactive learning and formative assessment activities. Each module has 3 components: gaining, applying, and checking knowledge. Videotapes of local and national experts, presenting on contemporary topics, are uploaded to the online learning platform thus giving real-life application. Content focuses on genetic, genomic, and epigenetic variables affecting population health outcomes as well as translation of research to be population inclusive. Each module concludes with an assessment of student knowledge, development of a personal action plan, and a continuing education unit certificate.
Pre- and postcourse, participants complete the Genomic Nursing Concept Inventory4 to measure the acquisition of foundational genomic concepts and complete a self-assessment to ascertain short-term acquisition of genetic and genomic competencies. The number of course referrals, research projects, and presentations stimulated by the course—plus monitoring collaborative efforts among alumni—will provide metrics of long-term successes. In the first cohort, 83 participants enrolled with 31% diverse representation. In addition, 51 (61%) participants completed the entire course with 98% reporting good, very good, or excellent satisfaction with content, their knowledge enhancement, and committed to change practice.
Summary and Future Directions
Nurses are a vital part of the biomedical workforce and need training about genomics as applied to research, clinical practice, and teaching. In this article, we presented an overview of our NIH/NHGRI-funded online long course, a novel approach to genomics education for diverse, doctoral-level nurses. Hopefully, course participants will further their education and be part of the group of nurses who go on to work in this component of biomedical research with an appreciation of why we must conduct such research with all populations. Participants who do not pursue genomics education beyond this course will have more knowledge about this topic as applied to their clinical practice and teaching, including recognition of the issues related to groups underrepresented in biomedical research.
As we continue to offer the course over a 5-year period, we will adopt a continuous quality improvement approach to keeping content relevant to a complex and changing health care environment. Alumni of our course will become an integral part of a pool of mentors and will connect to current students based on common interests, needs, and career trajectory, thus building a network of collegial scholars, clinicians, and educators.
1. Popejoy AB, Fullerton SM. Genomics is failing on diversity. Nature. 2016;538(7624):161–164. doi:10.1038/538161a
2. Wright H, Zhao L, Birks M, Mills J. Nurses' competence in genetics: an integrative review. Nurs Health Sci. 2018;20(2):142–153. doi:10.1111/nhs.12401
3. American Nurses Association. Essential genetic and genomic competencies for nurses with graduate degrees. Published 2011. Accessed August 28, 2022. https://www.genome.gov/Pages/Health/HealthCareProvidersInfo/Grad_Gen_Comp.pdf
4. Ward LD, Barbosa-Leiker C, French BF. Item and structure evaluation of the genomic nursing concept inventory. J Nurs Meas. 2018;26(1):163–175. doi:10.1891/1061-37188.8.131.52