Content area
Background
Precision health is emerging as standard of care in acute and ambulatory settings. Foundational education of genetic and genomic content is needed in prelicensure nursing curriculum. An International Society of Nurses in Genetics task force was created to identify key content for entry-level practitioners.
Method
The task force reviewed the literature and syllabi from existing undergraduate courses to inform the development of entry-level student genomic competencies.
Results
Nine genomic competencies were identified. A crosswalk mapped the competencies to select professional organization standards.
Conclusion
The crosswalk assists prelicensure nursing faculty to integrate genomic competencies into existing curriculum programs or stand-alone courses. Future steps include consultation with international nursing genomic experts to standardize curricular competencies for use by nurse educators around the world. The crosswalk links these competencies to professional standards, which provides robust demonstration of attention to accreditation requirements. [J Nurs Educ. 2025;64(X):XXX–XXX.]
Precision health is emerging as a standard of care in acute and ambulatory settings, requiring that foundational content pertaining to genetics and genomics be integrated into prelicensure nursing education curricula. The International Society of Nurses in Genetics (ISONG) is a global nursing specialty organization dedicated to genomic health care, education, research, and scholarship. The education committee of this organization meets monthly to advance dialogue pertaining to nursing education in the area of genomics. In multiple meetings held by ISONG, it was identified that key genomic content is not consistently integrated into curricula across prelicensure nursing programs. In response to this content gap, the ISONG Education Committee established a task force committed to creating a crosswalk of genomic competencies to correspond with select professional standards and guidelines for use by faculty in prelicensure nursing programs. The crosswalk was designed to address competencies required for entry-level nurses to practice safely and deliver quality care relative to precision health. Crosswalks are tools that provide opportunities for nurse educators to align competency-based learning outcomes with professional nursing standards and guidelines (Hai-Jew, 2019).
Genomic Literacy
Linking established genomic competencies to professional nursing standards and guidelines for prelicensure nursing curricula has not been completed (American Nurses Association [ANA], 2023). A key element of genomic competence is genomic literacy (ANA, 2023; Hai-Jew, 2019). Genomic literacy is defined as “the capacity to obtain, process, understand, and use genomic information for health-related decision-making” (Zimani et al., 2021, para 2). Genomic literacy will enable individual nurses to translate genomic content across settings as they interact with individuals, families, and communities (Parviainen et al., 2023). Failure to address nurses' genomic literacy within the context of professional standards may hinder integration of emergent and future precision models of health and health care delivery (ANA, 2023; Parviainen, 2023).
The need for genomic literacy in nursing curricula is not new. The NCLEX-RN®, an entry-level examination, does not specifically reference genetic or genomic content. A search of the NCLEX-RN Test Plan (ANA, 2023) document did not reveal the terms genetics, genomics, inheritance, or heredity. However, broad competencies related to the ability to monitor diagnostic testing and intervene as needed, identify pathophysiology related to acute or chronic conditions, educate patients, and collaborate with multidisciplinary team members when providing care are directly related to major categories on the test plan, such as reduction of risk potential, physiological adaptation, and management of care (National Council of State Boards of Nursing, 2023). As precision health becomes more of a priority, genomic literacy will become paramount for nurses. Broad statements reflective of competency relative to management of care for patients experiencing a variety of diseases is a high priority.
The first call to incorporate this content in nursing education curriculum began with Brantl and Esslinger in 1962. Yet today, more than 60 years later, genomic content within many nursing programs is inadequate (Seibert, 2020). The lack of genomic content in prelicensure programs leads to low genomic literacy among nursing students and practicing nurses globally (Chow et al., 2023; Dagan et al., 2021; Dewell et al., 2020; McCabe et al., 2016; Parviainen et al., 2023; Ward et al., 2016; Wright et al., 2019; Zureigat et al., 2022). To fully support the concept of precision health requires a renewed call to action for genomic content to be included in prelicensure nursing curriculum. Demonstrating the relationship of genomic content to contemporary standards and guidelines facilitates processes related to course design and creation of student learning outcomes, prompting student understanding (ANA, 2023).
The crosswalk is designed to address foundational genomic competencies required for entry-level nurses so that they may interpret diagnoses linked to genetic testing, identify familial risk, and evaluate laboratory results. This degree of literacy is necessary in order to communicate these complex concepts to individuals, their families, and the populations they serve (Barr et al., 2018; Campion et al., 2019; Inter-Society Coordinating Committee for Practitioner Education in Genomics [ISCC-PEG], 2023). The crosswalk supports faculty by providing key competencies they need for their own genetic literacy, as well as providing a template from which to work that captures critical knowledge and competencies for prelicensure students (Donnnelly et al., 2017; Smania et al., 2022).
Additionally, the crosswalk serves as a reference linking professional standards and guidelines with genomic competencies to assist faculty in developing curricula in their respective prelicensure programs. Competencies should be crosswalked to professional standards providing evidence for their accreditation requirements (i.e., American Association of Colleges of Nursing [AACN], Accreditation Commission for Education in Nursing [ACEN], etc.). Selected professional standards, such as ANA and the Interprofessional Education Collaborative (IPEC), are intended to serve as foundational support for competency development among prelicensure programs in nursing. As precision health care becomes the standard of care, the crosswalk can guide new stand-alone genomic course development or as a reference for threading the competencies throughout already developed courses in a prelicensure nursing program (Dewell et al., 2021; Parviainen et al., 2023; Whitley et al., 2020).
Method
The process for the development of a crosswalk was initialized by the task force committee. Literature generated by researchers and educators was reviewed to inform the creation of the crosswalk and elemental prelicensure nursing students' competencies. The taskforce committee searched PubMed®, Google™ Search, Medline®, and CINAHL® using the phrases “crosswalk for genetics and genomics,” “development of a crosswalk for undergraduate genetics and genomics,” and “creating a crosswalk for genetics and genomics,” which resulted in no findings. The search was expanded to include “crosswalks for undergraduates.” The search yielded three articles, which were used to guide creation of a crosswalk template (DeBlieck et al., 2023; Edgar et al., 2018; Fulton et al., 2022).
The taskforce committee used a 10-step process to identify the fundamental concepts for genomics competency in prelicensure education needed for entry-level practice. First, the taskforce committee reviewed the American Nursing Association's (ANA) Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics, initially published in 2006 with minimal knowledge level competencies (Lewis et al., 2006) and updated in 2008 with outcomes indicators (Consensus Panel on Genetic/Genomic Nursing Competencies, 2009). The updated 2023 Essentials included regulatory, academic, practice, leadership, and genomic content consensus to incorporate evidence-based genomics content into nursing education, practice, and regulation (Consensus Panel on Genetic/Genomic Nursing Competencies, 2023). Next, the committee reviewed the ISONG/ANA (2017) and AACN (2021) Essentials for prelicensure nursing students. The committee then reviewed two historical documents: (1) Core Competencies in Genetics for All Health Care Professionals, developed by an interdisciplinary group of health care providers led by the National Coalition of Health Professional Education in Genetics (2007); and (2) Genomics Competencies for all Public Health Professionals, developed by the U.S. Centers for Disease Control and Prevention (2001). These documents were used to generate a list of core competencies for genomics in nursing practice.
Next, the taskforce committee asked educators to provide examples of their genetic and genomic syllabi of existing courses to address key content. Five exemplars of undergraduate genomics nursing courses were reviewed for competencies and outcomes. All syllabi and key literature statements were critically reviewed to determine common themes, which resulted in the generation of the initial competencies. Bloom's taxonomy was consulted to identify action verbs that were used in the competency statements (Adams, 2015; Anderson & Krathwohl, 2001; Bloom, 1956). The competencies included simple to complex genomic content that prompts new-to-practice nurses to understand basic terminology, concepts, and genetic testing used in practice environments. Initial competencies were then reviewed by the committee through several iterations resulting in nine derived competencies. The nine competencies were sent for review by genomics education experts. Three doctoral-prepared education experts, who teach or guide curriculum development in genetic and genomic courses and are recognized by peers as experts through publications and practice, reviewed and revised the competencies for relevance to entry-level nursing practice. The completed competencies reflect genomic knowledge, attitudes, and skills, which may be aligned with individual courses or programmatic outcomes in a prelicensure program. These elements are strongly influenced by selected sets of contemporary professional nursing organization standards and guidelines.
Seven Professional Accreditation Organizations
The final step in the process was to identify professional organizations' standards and guidelines typically used by prelicensure programs for accreditation. These standards and guidelines are used to guide and develop prelicensure programs, implementation, and assessment of student learning outcomes. In general, faculty in schools of nursing are responsible for curriculum development (Godfrey, 2024). Along the educational trajectory, knowledge, attitudes, and skills are strongly influenced by selected sets of contemporary professional nursing organization standards and guidelines. Nurse faculty members select the guiding documents in alignment with their accrediting body for their program and their preference for espousing other professional organization beliefs about nursing practice and competency of nurses.
The taskforce committee opted to crosswalk standards, guidelines, and competencies: (1) Nursing: Scope and Standards of Practice (ANA, 2021); (2) The Genetics/Genomics Nursing: Scope and Standards of Practice (ANA/ISONG, 2016); (3) The Essentials: Core Competencies for Professional Nursing Education (AACN, 2021); (4) IPEC Core Competencies for Interprofessional Collaborative Practice (IPEC, 2023); (5) Quality and Safety Education for Nurses Competencies (QSEN, n.d.); and (6) National League for Nursing Competencies for Graduates of Nursing Programs (National League for Nursing Commission for Nursing Education Accreditation, 2021).
The developed crosswalk will assist organizations to demonstrate how they are meeting accreditation requirements as they develop or include genomics content for their prelicensure nursing programs.
Results
The nine competencies were aligned in a crosswalk to the professional organizations' identified goals and objectives, including the updated Essentials (AACN, 2021), to support prelicensure nursing students' genomics literacy (Table A; available in the online version of this article). Each of the concepts, domains, and objectives from the professional organizations' standards are listed in Table A according to the corresponding numbers or titles that are in the original publication from each organization. For example, each of the AACN Essentials 10 Domains are listed by their number, and the four IPEC core concepts are listed by their title in the rows that correspond with each of the nine competencies in Table A. The references for the full publications are included in the reference list (AACN, 2021; ANA, 2021; IPEC, 2023; ANA/ISONG, 2016; National League for Nursing Commission for Nursing Education Accreditation, 2021; QSEN, n.d.). The nine competencies are listed below in order of lower to higher cognitive skills based on Bloom's taxonomy (Adams, 2015; Anderson & Krathwohl, 2001; Bloom, 1956):
Describe how genetic traits and predispositions affect health outcomes.
Discuss the role of the nurse as part of an interprofessional team that facilitates the delivery of precision health to improve health outcomes for patients, families, communities, and populations.
Identify surveillance efforts to monitor safe care delivery and response to treatment (e.g., pharmacogenomics).
Apply principles of genetics and genomics to inform decision making within nursing practice for patients, families, and population.
Examine ethical, legal, economic, and social issues related to genetics and genomics in the provision of health care for individuals, families, and populations.
Outline how the interaction of genes, demographics, behaviors, and environmental factors influence health across the life span.
Select current, credible genetics and genomics information and resources to inform evidence-based practice and policy development.
Evaluate the multifactorial components involving genetics and genomics, such as the social determinants of health (SDOH) and the environmental and behavioral risk factors related to disease (epigenetics).
Perform health history assessments to identify individuals and families who may benefit from referral to genetic services.
| Genetics/Genomics Crosswalk for Undergraduate Nursing | |||||||||
|---|---|---|---|---|---|---|---|---|---|
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| Competency | ANA Standard | ANA 2023 Essentials Domain | ISONG/ANA | AACN Essentials Concept | AACN Essentials Domain | IPEC | QSEN | NLN* | NLN Integrating Concept |
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| 1. Describe how genetic traits and predispositions affect health outcomes. | 13, 14, 18 | Domain 1. Nursing Assessment, Applying/Integrating Genomic Knowledge | 2, 9 | Communication; Diversity, Equity & Inclusion; SDOH | 3 | Roles/Responsibilities | Patient-Centered Care | Enhance Human Flourishing | Context and Environment |
| Domain 2. Identification | |||||||||
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| 2. Discuss the role of the nurse as part of an interprofessional team that facilitates the delivery of precision health to improve health outcomes for patient, families, communities, and populations. | 1, 2, 3, 4, 5, 5A, 5B, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 | Domain 3. Referrals | 1, 2, 3, 4, 5, 5A, 5B, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 | Communication; Compassionate Care | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 | Roles/Responsibilities | Teamwork | Develop a Professional Identity | Personal and Professional Development; Teamwork |
| Domain 4. Provision of Education, Care, and Support | Teams and Teamwork | ||||||||
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| 3. Identify surveillance efforts to monitor safe care delivery and response to treatment (e.g., pharmacogenetics). | 1, 3, 4, 5A, 5B, 6, 8, 9, 10, 11, 13, 14, 17, 18 | Domain 4. Provision of Education, Care, and Support | 3, 9, 10, 16 | Communication; Health Policy | 1.2, 1.3, 5.1, 6.2, 9 | Values/Ethics for Interprofessional Practice, Teams, and Teamwork | Safety | Demonstrate Sound Nursing Judgment | Quality and Safety |
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| 4. Apply principles of genetics and genomics to inform decision making within nursing practice for patients, families, and populations. | 5A, 9, 10, 13, 14 | Domain 1. Nursing Assessment, Applying/Integrating Genomic Knowledge | 5A | Clinical Judgment; Evidence-Based Practice | 1, 2, 3 | Roles/Responsibilities | Patient-Centered Care | Demonstrate Sound Nursing Judgment | Knowledge and Science |
| Domain 4. Provision of Education, Care, and Support | |||||||||
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| 5. Examine ethical, legal, economic, and social issues related to genetics and genomics in the provision of health care for individuals, families, and populations. | 4, 7, 8, 9, 10 | Domain 2. Identification | 7, 8 | Compassionate Care; Ethics; Health Policy; Communication | 3 | Values/Ethics for Interprofessional Practice | Safety | Develop a Spirit of Inquiry | Context and Environment; Knowledge and Sciences; Relationship Centered Care; Teamwork |
| Domain 4. Provision of Education, Care, and Support | |||||||||
|
| |||||||||
| 6. Outline how the interaction of genes, demographics, behaviors, and environmental factors influence health across the life span. | 1, 2, 3, 4, 5A, 13, 14, 18 | Domain 1. Nursing Assessment: Applying/Integrating Genomic Knowledge | 9, 16 | Clinical Judgment; Diversity, Equity & Inclusion; Social Determinants of Health | 1.2 | Roles/Responsibilities, Interprofessional Communication | Patient-Centered Care | Enhance Human Flourishing | Context and Environment; Knowledge and Sciences; Relationship-Centered Care; Teamwork |
| Domain 2. Identification | |||||||||
| 7. Select current credible genetics and genomics information and resources to inform evidence-based practice and policy development. | 5B, 6, 8, 9, 10, 12, 13, 14, 15, 16, 17 | Domain 2. Identification | 8, 9, 15, 16 | Clinical Judgment; Communication; Health Policy | 2.2, 4, 5, 6.3, 7.2, 7.3, 8, 10.2 | Roles/Responsibilities, Interprofessional Communication | Informatics, Patient-Centered Care, Safety | Demonstrate Sound Nursing Judgment; Exhibit a Spirit of Inquiry | Knowledge and Science; Personal and Professional Development |
| Domain 4. Provision of Education, Care, and Support | |||||||||
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| 8. Evaluate the multifactorial components involving genetics and genomics, such as SDOH and environmental and behavioral risk factors related to disease (e.g., epigenetics). | 5B, 9, 11, 18 | Domain 1. Nursing Assessment: Applying/Integrating Genomic Knowledge | 9, 16 | SDOH | 5, 9 | Values/Ethics for Interprofessional Practice | Patient-Centered Care | Enhance Human Flourishing; Exhibit a Spirit of Inquiry | Context and Environment; Relationship-Centered Care |
| Domain 2. Identification | |||||||||
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| 9. Perform health history assessments to identify individuals and families who may benefit from referral to genetic services. | 1, 2, 3, 4, 5B, 6, 7, 8, 9, 10 | Domain 1. Nursing Assessment, Applying/Integrating Genomic Knowledge | 1, 5A, 5B, 13, | Clinical Judgment; Communication; Evidence-Based Practice; SDOH | 2, 6.2 | Roles Responsibilities, Interprofessional Communication, Team and Teamwork | Patient-Centered Care, Teamwork and Collaboration | Enhance Human Flourishing | Context and Environment; Knowledge and Sciences; Relationship-Centered Care; Teamwork |
| Domain 2. Identification | |||||||||
| Domain 3. Referral Activities | |||||||||
Conclusion
To remedy the underutilization of genomics content within prelicensure nursing programs, the crosswalk links professional standards and guidelines to prelicensure student learning outcomes. The crosswalk provides robust attention to accreditation requirements. Identification of key genetic and genomics content supports faculty to prepare prelicensure students to render precision health care. Nursing curriculum programming will align genomics content with contemporary professional standards. The crosswalk provides learning outcomes to address the emergent and future precision and personalized models of health and health care.
To support faculty, the crosswalk provides them with a template from which to work that captures fundamental critical knowledge and competencies in the areas of genomics nursing. The nine competency statements were intentionally designed so that they can be measured. The relationship of the standards to the statements is based on the authors' consensual interpretations of the standard. The crosswalk is not intended to be prescriptive but rather serve as a template for educators to advance their teaching pedagogy. As precision health becomes the standard of care, nurses require genetic literacy to guide, counsel, and interpret complex ideas to the individuals and populations they care for (ANA, 2023). In addition, nurses require insight into how social drivers of health, such as stress and environment, contribute to epigenetic changes and adverse health outcomes (Ray et al., 2023). Genetic literacy must begin in prelicensure training for nurses to meet the challenges of future health care.
Recommendations
Future steps to use the crosswalk will include consultation with international nursing genomic experts. Standardized curricular content for nurse educators around the world varies, as standards, accreditations, and cultures dictate the level of inclusion of genomic content into nursing programs (Calzone et al., 2018; Dewell et al., 2021). The goal of task force members is to have prelicensure nursing programs initiate new stand-alone genomics courses or to have the material presented in already developed courses in prelicensure nursing education programs. The authors acknowledge the emphasis that accreditation standards place on assessing student learning. The nine student competency statements were intentionally constructed to facilitate measurement. Identification of learning experiences and assessments are beyond the scope of this article but will be important to discuss in a future manuscript.
Future steps include the development and analysis of strategies to evaluate nursing competencies in the area of genomics. The nine competency statements presented in this article reflect general concepts related to genomic literacy and can serve as a template to guide the development of learning experiences that are aligned with professional organizations' standards and guidelines for accreditation of prelicensure nursing programs. There can be diversity of thought among faculty influenced by their unique prelicensure curriculum plans. Strategies designed for teaching and assessment are faculty-driven and can be linked to each of the nine competency statements. Genomic nurse competency is integral to the delivery of precision health care.
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From Salisbury University, Salisbury, Maryland (JW); George Washington University, Washington, D.C. (KW); University of Connecticut, Storrs, Connecticut (RL); and Thomas Jefferson University, Philadelphia, Pennsylvania (MH-Z).
Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
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