Download The Hidden Curriculum: What Are We Actually Teaching

SPECIAL FOCUS ON THE FUNDAMENTALS OF CARE
The Hidden Curriculum: What Are
We Actually Teaching about the
Fundamentals of Care?
Kathleen MacMillan, PhD, RN
Professor and Director, School of Nursing, Dalhousie University
Halifax, NS
Abstract
The issues of missed or inadequately provided basic nursing care and related
complications are being identified as worldwide phenomena of interest. Without
being aware of it, educators and practicing nurses may be teaching nursing students
that fundamental nursing care is unimportant, uncomplicated and not really nursing’s responsibility. This paper explores the concept of the “hidden curriculum” in
nursing education, as it relates to fundamental nursing care and calls for greater
partnerships between education and service to uncover the hidden curriculum;
to effectively shape it to achieve alignment between classroom and practice; and,
ultimately, to improve care processes and patient outcomes through collaboration.
A renewed focus on the vital importance of what is considered “basics” to patient
outcomes is required in nursing education.
Something insidious is happening in a wide range of institutional settings and in
many jurisdictions. Patients and families are complaining about the apparent lack
of attention to basic nursing care (Feo and Kitson 2016). Recently, a Yale professor of medicine (Krumholtz 2013) published an article describing the impact of
hospitalization on patients (due to deprivation of sleep, nutrition and exercise)
that is leading to readmission for a problem not associated with the original
hospital admission diagnosis. In response, Kalisch (2015: 84) linked this to missed
nursing care, the “required and standard nursing care that is not being completed.”
Kalisch asserts that there is a large amount of omitted care, including ambulation, mouth care, feeding and turning in patient care settings. Omissions in nursing care came to a critical point with the release of the Francis report on the Mid
Staffordshire Foundation NHS Trust in the UK which resulted in over 60 recommendations directed to all levels of the organization (NHS 2013). Interestingly, the
political impact of the report seemed to focus on nurses and nursing education to
explain the gaps and lack of “compassionate” care (Reeves et al. 2014).
37
38
Nursing Leadership Volume 29 Number 1 • 2016
One of the puzzles about the apparent lack of practice focus on the basics of
providing nursing care to patients is how and why this happens. What forces and/
or factors operate to diminish the importance of ensuring that patients are fed,
hydrated, cleansed, mobilized and kept safe from the harms that result from lack
of basic nursing care (Feo and Kitson 2016)? This is care that nurses traditionally perform on behalf of the healthcare team. One of the answers may lie in what
we are teaching nursing students and new graduates in practice without even
knowing that we are teaching it. This is termed in the pedagogical literature as
the “hidden curriculum” (Jackson 1968, Pinar 1995). The hidden curriculum has
seen prominence in medical education literature for the past 15 years and is a
frequent topic of conversation among those in the medical academy, particularly
in the areas of professional formation and ethics (Chuang et al. 2010; Gofton and
Regehr 2006; O’Callaghan 2013; Mossop et al. 2013; Stern and Papadakis 2006;
Sturman et al. 2012; Wear and Skillcorn 2009). While present in the nursing literature (Allan et al. 2011; Chen 2015; Edwards et al. 2002; Feo and Kitson 2016; Jafree
et al. 2015; Karimi et al. 2014; Nelson 2012), the term “hidden curriculum” has
received relatively less attention from academic nursing and, where it is present in
the literature, it may not be described by this term.
The Hidden Curriculum
According to Allan et al. (2011), the hidden curriculum exists in many professional curricula, “and it functions to socialise students into professional behaviours and practice” (p. 847). Informal curriculum can be ascribed to “what
occurs in clinical settings – opportunistic, idiosyncratic, pop-up and sometimes
unplanned instruction” (Wear and Skillcorn 2013: p. 452). The hidden curriculum includes subliminal messages in both the formal and informal curricula
that can be transmitted through multiple pathways. It may be hidden in prevailing hegemony of healthcare and educational environments. Precisely because it
is based on values and assumptions that we accept as widely shared truths, we
allow it to go unchallenged, unexamined and uncritiqued. These assumptions are
culturally acquired over long periods and, in nursing, are often entangled with
assumptions about the roles of women in society. Some basic nursing care may
remain firmly associated with perceptions of either domestic or maternal tasks
performed by homemakers or mothers. Such care is often relegated to unregulated
care providers (who are most often women). Nursing is still an engendered profession in many parts of the world, despite efforts to achieve more gender balance
(McLaughlin et al. 2010).
The Hidden Curriculum in Nursing Education
The hidden curriculum is conveyed to students within the formal curriculum
through choice of lecture content and assigned readings and as sub-text through
multiple media (social, classroom, clinical experiences, role modeling and by
The Hidden Curriculum: What Are We Actually Teaching about the Fundamentals of Care?
example (Edwards et al. 2002). Because it is largely covert, it is very powerful and
hard to change. Hidden curriculum is also difficult to address because nursing
students come with a host of values and attitudes that they have acquired through
basic socialization. We may learn very early archetypical concepts such as “nursing is a women’s profession” and that “kindness is the primary requirement to be
a good nurse.” These are frequent sub-texts that are conveyed through the media,
and in educational, family and social settings, which may not be openly challenged
in nursing education.
Nursing education takes place within the complex interaction of the classroom,
the laboratory and practice. The hidden curriculum may not be part of the formal,
overt course content, but it can be reinforced within it through language, such as
always referring to the nurse by feminine nouns and pronouns. This is exclusionary language that impacts male students. In nursing school, either in the classroom, the simulation and clinical skills laboratory, or in clinical practice, nursing
students may only see female role models except at the highest level of the organization. This conveys hidden messages about male and female roles and relative
power within a hierarchical organizational structure that is rarely critiqued.
Use of such phrases as the importance of following “medical orders” and hospital
policies and procedures can convey a value that these things are more important
than person centredness, nursing clinical judgements and even nursing tasks. The
fact that physicians still write orders for nursing care – ambulation, toileting, hygiene
and feeding – may reinforce that nurses lack control over their own practice. In the
absence of a written medical order, nurses may not take ownership for ensuring that
basic nursing care is provided in a timely and appropriate way. There are likely to
be care delays because nurses are socialized to wait for a physician to order nursing
care, and accountability for missed or delayed nursing care may be attributed to the
lack of a medical order. In addition, there may be lack of clarity around the roles and
accountabilities of various providers, such as the role of the physiotherapist and the
nurse, in initiating ambulation of patients (Feo and Kitson 2016).
If lecture content is biased towards medical evidence over nursing evidence and
we emphasize the importance of technical skill mastery over other cognitive abilities and competencies, we are conveying important messages without being fully
aware of them. Students may receive the hidden message that a good nurse is
someone who can skilfully and efficiently get all the tasks done in a set time and
that relational skills are less valued. Within a faculty, not all may hold the same
values and attitudes about nursing or about how to teach nursing and there are
few opportunities provided for faculty to have open dialogue about these important values. Even fewer opportunities exist for academics and clinicians to jointly
engage in discourse about what is often termed the “academic-practice” gap.
39
40
Nursing Leadership Volume 29 Number 1 • 2016
The Important Role of Faculty
Canada moved to baccalaureate education as entry to practice for registered
nurses fairly recently (except for the province of Quebec). This transition took
place in many jurisdictions over the past 20 years by combining faculty and
resources from diploma and degree programs. In many other jurisdictions, nursing is still a college-level program. Uncovering the hidden curriculum is complex
because it can be found in the values unknowingly transmitted by individual
faculty. There may still be active faculty who believe that nursing is really about
clinical skills; a technical occupation rather than a cognate profession. I would
argue that this view of nursing is still dominant in many institutional practice
settings where students may be supervised by preceptors who emphasize the technical performance of skills in their instruction, particularly if these are complex
skills that were formally the province of the physician.
Students may encounter nursing colleagues and other members of the healthcare
team who perceive nursing to be dependent and subservient to medicine and other
health professions. Openly challenging information provided by a faculty member
or clinical preceptor may be actively or passively discouraged, role-modeling to
students to accept the status quo and be obedient, rather than questioning and
critical. Some settings have institutional policies that do not permit nurses to access
Web-based or online information in the clinical setting; that prohibit the use of
electronic communication devices in the workplace or at the point of care; and/or
nurses may have limited access to computers or email and Internet accounts that
could link them to current evidence and communities of practice. The subtext of
this prohibitive policy is that nurses do not require access to primary source clinical
information and should rely on what is provided – a received view of rules-based,
prescriptive practice that is not tailored to the individual patient. Organizational
policies and procedures and care maps may emphasize caring for the medical diagnosis or treatment over caring for the person. (There is also an unchallenged assumption that nurses would misuse Internet access for personal or social
purposes – a powerful element of hidden curriculum).
As educators, we are often unaware of the messages we are transmitting informally
or through our own behaviour. The origins of uncivil behaviour in practice settings
may lie in how faculty treat students and each other – behaviour that is witnessed by
students (del Prato 2013). If faculty and clinical instructors witness substandard or
outdated care in a practice setting and choose not to act on it, we are teaching students
something about how nurses should address gaps in care and the potential conflict
that is a normal part of changing practice. As eloquently summed up by Nelson:
“In this ‘crapshoot’ [sic] of good, average and horrendous placements, we
are teaching the next generation of nurses two grim lessons: 1. It is what it is.
You must take it as it comes and continually adapt to the system and
The Hidden Curriculum: What Are We Actually Teaching about the Fundamentals of Care?
2. Develop resilience. You must put up with colleagues who do not like
students, don’t like new graduates, or, frankly, don’t like you.” (Nelson 2012: 5)
The Impact on Evidence Informed Care
Research and application of evidence to care matter. We have evidence that
missed nursing care impacts patient outcomes (Krumholtz 2013, Kalisch 2015).
It is difficult, however, to secure funds for research into basic nursing care
processes and the relationship with phenomena such as “post-hospital syndrome”
(Krumholtz 2013). It is hard to interest other care team members in this research
so that nursing questions are part of team-based research studies on readmission and outcomes. The culture of applying evidence to practice in nursing still
needs development, and we still have a lot to learn about how evidence is effectively transferred to nursing practice (Edwards et al. 2002, Dogherty et al. 2013).
Nursing data elements may not be routinely collected in administrative databases, and these may be missing or not easily linked and accessible. Information
collected by nurses is rarely communicated back to inform nursing care processes
and outcomes. Without key data elements in administrative data sets and access
to adequate funding, we may be hampered in conducting such research, engaging
students in it or citing available current and published literature in our teaching. We may not be providing students with evidence of possible links between,
for example, omission of regular toileting and hospital delirium in the elderly
or mouth care and ventilator-acquired pneumonia. We may, therefore, unwittingly be teaching these nursing skills as routinized tasks, divorced from evidence
and from impact. Concurrently, we may be citing available medical literature to
illustrate the importance of evidence-informed medical care, relegating nursing
knowledge to a lower level of influence and importance.
Clinical instructors are often contract, short-term employees who come and go,
depending on the availability and need. Preceptors are volunteer staff nurses, often
selected on the basis of willingness to take a student in a particular practice setting
and sometimes “assigned” to be a preceptor without their knowledge until the
student contacts them. Both of these categories of nursing educators are together
responsible for teaching 30%–40% of the curriculum in small groups or even in a
1:1 relationship. Thus, they are very influential, and maybe even more so than nursing faculty, but often poorly engaged with the curriculum and with the faculty and
school of nursing. The use of evidence to guide nursing care may be ignored if not
rejected. We pay relatively less attention to the professional development, engagement and evaluation of clinical instructors and preceptors than we do regular
faculty in the context of hard-to-find placements and instructors. The opportunity
for these individuals to shape the student’s perception of what is important in practice, including the role of evidence, is, however, very powerful. We still have many
practicing colleagues who tell their students to forget everything they learned in
class about theory and pay attention to how it really works in practice.
41
42
Nursing Leadership Volume 29 Number 1 • 2016
Curriculum Structure and Design
The sequence of teaching specific content can contribute to hidden curriculum.
In most nursing curricula, we teach fundamentals of nursing care in the initial
courses of the curriculum and rarely revisit them through a theoretical- or
evidence-based lens. We often assign nursing students to unregulated care assistants in long-term care settings to first practise these skills (Ferguson and Jinks
1994, Feo and Kitson 2016). Unwittingly, we are teaching that these care processes
are very basic tasks that can be carried out by almost anyone. Even more concerning, we may be conveying that this is not nursing work. Because of early, technically focused, atheoretical instruction and experience in fundamental nursing
care, nursing students may neither feel accountable for monitoring and ensuring
that basic nursing care is appropriately provided by unregulated staff nor for
evaluating related outcomes. As students progress through the curriculum, this
care can become invisible and taken for granted by instructors and preceptors
and rarely assessed and reinforced – just as it is taken for granted and invisible in
practice settings. Such care only really becomes visible by its absence and associated complications. Clinical supervision for students can become more focused on
those care elements that involve the medical plan of care – diagnostic procedures,
medications, IV fluids and management of tubes and lines.
Documentation Systems as Hidden Curricula
Documentation systems may unintentionally reinforce a lack of focus on nursing basics or fundamental elements by relegating recording of nursing care to a
simple tick box and an initial. Omissions in such care are rarely examined and/or
explained as part of quality assurance audits, or linked to outcomes. The impact
of electronic health records (EHR) on subliminally prioritizing tasks should not be
overlooked.
Concerns have been raised about how data is [sic] selected, shaped and
represented by software in ways which are not always apparent to those
using computer technologies. In this sense, software can be considered as
part of the hidden curriculum of education. (Edwards 2015: 65)
If the EHR places little emphasis on the need to document basic nursing care or
does not provide space for narratives to record patient conversations or clinical factors that impede completing such care (such as an endotracheal tube or
dementia and difficult provision of proper mouth care), there is a message regarding the importance of such care. If it is conveyed by the documentary system to
be more important to complete the assessment of decubitus ulcer risk than to
actually turn the patient, students are processing those messages. In many cases,
electronic documentation is taking up more nursing time than with paper records
and reducing direct care nursing contact, conveying a message of priority of
documentation over care.
The Hidden Curriculum: What Are We Actually Teaching about the Fundamentals of Care?
The Busy Script
In practice settings where nurses are busy and emphasis is placed on efficiency and
getting tasks and procedures done, it is relatively easy to see how we might socialize nursing students to focus on “time and task” in place of “thinking and linking”
(Kitson et al. 2014). A care assistant view of fundamental care processes might well
be to get the task done as quickly as possible to tick it off the list. Such a focus might
lead to placing a patient in an incontinence brief or diaper in place of ambulating
the person to the toilet and doing mouth care, grooming and basic hygiene while in
the washroom. A professional nursing view would consider the patient’s experience
of being loaded onto a shower commode, hosed off, dried, gowned, diapered and
returned to the bed in place of the therapeutic value of replicating normal hygiene
routines. The impact of the depersonalization and deconditioning experienced by
a task-based type of care can be hypothesized to be related to a higher risk for falls
and delirium in the elderly. Nurses are expected to take a leadership role in changing the focus of care from task completion to person centredness, but we often hear
that nurses are “too busy” to carry out these tasks in more than perfunctory ways.
Shifting the dialogue from one of “too busy” to care to one of “how do we ensure that
important nursing care is delivered” is a vital clinical leadership role. This shift would
require that nurses at all levels of education and practice need to be more active in
leadership and change management activities related to nursing care processes.
What to Do?
There are two main foci for action to address the impact of the hidden curriculum
on strengthening our approach to fundamentals of care. First, we must engage clinical instructors more actively in the world of nursing education and see this as a vital
partnership that requires nurturing and supportive structures and processes. Second,
we need to commit to creating a more explicit evidence base around fundamental care
throughout the learning environment (classroom, simulation and clinical practice).
Nurse educators in academia and in practice must first initiate conversations on
what is formally, informally and in hidden ways, actually being taught to nursing students and new graduates. We must first be more self-aware and reflective
and devote time and attention to what we are saying and what we are hearing in
everyday practice. There is a need to create spaces for dialogue on our philosophy
of nursing as a practice discipline to ensure that faculty are conveying coherent information to students through all teaching modalities. The goal should be
for alignment in what we teach and what students experience if we are to create
clinical practice spaces that make visible, support and value fundamental nursing care. Reinforcing the formal curriculum in the practice setting (scholarly
practice) requires closer relationships between preceptors and clinical teachers
with full-time faculty and the nursing school (Ferguson and Jinks 1994). These
personnel, who are a vital part of the preparation of the next generation of
nurses, are often only peripherally connected to the school, the learning outcomes
43
44
Nursing Leadership Volume 29 Number 1 • 2016
and the school’s formal curriculum. To them, what students are learning in the
classroom is a “black box” that they are neither adequately informed about nor
engaged in and are therefore not able to contribute to.
… we are teaching far more than we know. Every word we speak, every
action we perform, every time we choose not to speak or act, every smile,
every curse, every sigh, is a lesson in the hidden curriculum. (Gofton and
Regehr 2006: 2)
We need sound research in the teaching and learning of nursing that informs
curriculum content, structure and teaching methods (scholarly teaching). Most
of us are still teaching as we were ourselves taught – the good, the bad and the not
so good. As a profession, we need to transition clinical evaluation of students and
new graduates from a focus on efficient task completion to one that includes the
experience of care recipients, care processes, application of evidence, barriers and
enablers and on actual patient outcomes that can be linked to fundamental nursing care. EHRs are here to stay; how do we ensure that they are shaping nursing
documentation in a way that makes nursing care processes and links to patient
outcomes visible and researchable. The mandatory inclusion of minimum nursing
data sets in the EHR software is a vital leadership issue.
We also need to conduct more evaluation research that links patient outcomes to
nursing care and to real costs and benefits. We need to shift the view of nursing
care from an institutional cost centre to a value proposition. Finally, we need to
give nursing faculty, clinical teachers, preceptors and students the tools to effectively lead and influence change by applying evidence to care processes. Where
fundamental care becomes complex because of the context or unique patient
characteristics, we need to support clinical nurses to design care processes that
work. This can only be accomplished with closer relationships and partnerships
with the service sector as we collaborate on a shared agenda to ultimately improve
patient care and outcomes. In this way, nursing will truly become a value proposition to the healthcare system. We hold it in our heads, hearts and hands to reduce
the costs to patients, the system and society that are associated with missed nursing care and we are all accountable for it. Nursing is a practice discipline and so
the practice of nursing must matter to all of us, no matter what role we are in.
In the words of a Zen proverb: “Before enlightenment: chop wood, carry water.
After enlightenment: chop wood, carry water. “
Correspondence may be directed to: Kathleen MacMillan, PhD, RN, Professor and
Director, School of Nursing, Dalhousie University, 5869 University Ave., PO Box
15000, Halifax, NS, B3H 4R2.
The Hidden Curriculum: What Are We Actually Teaching about the Fundamentals of Care?
References
Allan, H.T., P. Smith and M. O’Driscoll. 2011.”Experiences of Supernumerary Status and the Hidden
Curriculum in Nursing: A New Twist in the Theory-practice Gap?” Journal of Clinical Nursing 20(5):
847–55. doi:10.1111/j.1365-2702.2010.03570.x.
Chen, R. 2015. “Do as We Say or Do as We Do? Examining the Hidden Curriculum in Nursing
Education.” Canadian Journal of Nursing Research 47(3): 7–17.
Chuang, A.W., F.S. Nuthalapaty, P.M. Casey, J.M. Kaczmarczyk, A.J. Cullimore, Dalrymple, J.L. et al.
2010. “To the Point: Reviews in Medical Education - Taking Control of the Hidden Curriculum.”
American Journal of Obstetrics & Gynecology 203(4): 316.e1–e6.
Del Prato, D. 2013. “Students’ Voices: The Lived Experience of Faculty Incivility as a Barrier to
Professional Formation in Associate Degree Nursing Education.” Nurse Education Today 33(3):
286–90. doi:10.1016/j.nedt.2012.05.030.
Dogherty, E.J., M.B. Harrison, I.D. Graham, A.D.Vandyk, and L. Keeping-Burke. 2013. “Turning
Knowledge into Action at the Point of Care: The Collective Experience of Nurses Facilitating the
Implementation of Evidence-Based Practice.” World Views on Evidence-Based Nursing 10(3): 129–39.
Edwards, H., H. Chapman and L.M. Davis.2002, “Utilization of Research Evidence by Nurses.”
Nursing and Health Sciences 4(3): 89–95.
Edwards, R. 2015. “Software and the Hidden Curriculum in Digital Education.” Pedagogy, Culture
& Society 23(2): 265–79. doi:10.1080/14681366.2014.977809.
Feo R. and A. Kitson, 2016. “Promoting Patient-Centred Fundamental Care in Acute Healthcare
Systems.” International Journal of Nursing Studies 57:1–11.
Ferguson, K. and A.M. Jinks.1994. “Integrating What is Taught with What is Practiced in the Nursing
Curriculum: A Multi-Dimensional Model.” Journal of Advanced Nursing 20(4): 687–95.
Gofton, W. and G. Regehr. 2006. “What we Don’t Know we are Teaching: Unveiling the
Hidden Curriculum” Clinical Orthopaedics & Related Research 449: 20–27. doi:10.1097/01.
b1o.0000224024.96034.b2.
Jackson, P. 1974. Life in Classrooms. New York, NY: Holt, Rinehart & Winston.
Jafree, S.R., R. Zakar, F. Fischer and M.Z. Zakar. 2015. “Ethical Violations in the Clinical Setting: The
Hidden Curriculum Learning Experience of Pakistani Nurses.” BMC Medical Ethics 16: 16-015-0011-2.
doi:10.1186/s12910-015-0011-2.
Kalisch, B. 2015. “The Post-hospitalization Syndrome: Can Nursing Make the Difference?” Nurse
Leader 13(1): 84, 81.
Karimi, Z., T. Ashktorab, E. Mohammadi and H. Abedi. 2014. “Influential Factors on Learning
Through the Hidden Curriculum in the Perspective of Undergraduate Baccalaureate Nursing
Students.” Journal of Advances in Medical Education & Professionalism 2(2): 53–57.
Kitson, A., A.A. Althlin and T. Conroy. 2014. “Anything but Basic: Nursing’s Challenge in Meeting
Patients’ Fundamental Care Needs.” Journal of Nursing Scholarship 46 (5): 331–39. doi:10.1111/jnu.12081.
Krumholtz, H.M. 2013. “Post-hospital Syndrome – an Acquired, Transient Condition of Generalized
Risk.” New England Journal of Medicine 368(2): 100–02 doi:10.1056/NEJMp1212324.
McLaughlin, K., O. Muldoon and M. Moutray. “Gender, Gender Roles and Completion of Nursing
Education: A Longitudinal Study.” Nurse Education Today 30(4): 303–307.
Mossop, L., R. Dennick, R. Hammond and I. Robbe, 2013. “Analyzing the Hidden Curriculum: Use
of a Cultural Web.” Medical Education 47(2): 134–43. doi:10.1111/medu.12072.
Nelson, S. 2012. “The Hidden Curriculum.” The Pulse Spring/Summer: 4–6.
National Health Service. 2013. “Mid Staffordshire NHS Foundation Trust Public Inquiry.” Retrieved
January 27, 2016. <http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.
midstaffspublicinquiry.com/>
45
46
Nursing Leadership Volume 29 Number 1 • 2016
O’Callaghan, A. 2013. “Emotional Congruence in Learning and Health Encounters in Medicine:
Addressing an Aspect of the Hidden Curriculum.” Advances in Health Sciences Education: Theory and
Practice 18(2): 305–17.doi:10.1007/s10459-012-9353-4.
Pinar, W.F. 1995. Understanding Curriculum: An Introduction to the Study of Historical and
Contemporary Curriculum Discourses. New York, NY: Peter Lang.
Reeves, S., F. Ross and R. Harris. 2014. “Fostering a “Common Culture”? Responses to the Francis
Inquiry Demonstrate the Need for an Interprofessional Response.” Journal of Interprofessional Care
28 (5): 387–89 doi:10.3109/13561820.2014.921985
Sturman, N.J., M. Parker and M.L. van Driel. 2012. “The Informal Curriculum - General Practitioner
Perceptions of Ethics in Clinical Practice.” Australian Family Physician 41(12): 981–84.
Stern, D.T. and M. Papadakis. 2006. “The Developing Physician – Becoming a Professional.” New
England Journal of Medicine 355(17): 1794–99.
Wear, D. and J. Skillcorn. 2009. “Hidden in Plain Sight: The Formal, Informal, and Hidden Curricula
of a Psychiatric Clerkship.” Academic Medicine 84(4): 451–58.
Help Advance Nursing informatics knowledge by supporting
this first-ever scholarship named in honour of an
internationally recognized nursing informatics pioneer,
Dr. Kathryn Hannah.
Nurses are the biggest users of Health
Informatics Solutions, delivering care
24/7 in every setting, in every region
across Canada and around the world.
Nurses impact the outcomes of
care, enabled by information and
communication technologies.
We need more nurses prepared at the
graduate level with experience in health
informatics.
Visit cnf-fiic.ca for more information about the scholarship,
and gofundme.com/NIScholarship to make an online donation.
104276_CNF_PC.indd 2
15-05-14 4:29 PM