Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing

Sabbatical Report: Statewide Nursing Articulation

The Nursing Shortage & Nursing Education:

Issues, Implications, Process and Transformation

Deanna Suggs, RN, MSN, FNPCNMSU Carlsbad Nursing Department

Director/Professor of NursingFall 2007

SABBATICAL OBJECTIVES1. Compare and contrast all unified statewide

nursing curriculum versus basket curriculums (states to evaluate: Texas, Alabama).

2. Discuss with NMSU nursing director, Allied Health Dean, and other stakeholders the goals and conceptualization of the curriculum desired for NMSU.

3. Identify methods to facilitate articulation between the 2-year A.D.N. and 4-year B.S.N. programs within the NMSU system.

SABBATICAL OBJECTIVES

4. Analyze the commonalities, key components, and difficulties associated with both forms of nursing curriculum.

5. Evaluate how funding and accreditation can be equitably addressed with each form of

curriculum.

6. Identify stakeholders to be involved in a nursing curriculum transition.

SABBATICAL OBJECTIVES

7. Estimate the number of students who successfully articulate with a unified form of nursing curriculum.

8. Propose a more seamless curriculum for the nursing programs of the NMSU system.

9. Possibility of submitting one journal article.

SABBATICAL ACTIVITIES1. Attended all NM State Board of Nursing

meetings (Albuquerque, NM).

2. Completed new NMSU Carlsbad Nursing Program Handbook.

3. Assisted in paramedic meetings/class.

4. Participated in radio show promoting NMSU Carlsbad and Nursing Program with Dr. Pearson.

SABBATICAL ACTIVITIES5. Attended NLN Nurse Educator Conference

and interviewed nurse leaders on articulation.

6. Attending meetings regarding clinicals in Texas.

7. Was appointed an NLN site visitor and attended training in Minneapolis.

SABBATICAL ACTIVITIES

8. Wrote HED report, met with Carlsbad Foundation, and wrote a quarterly report.

9. Appointed NLAC executive commissioner. Attended training and meeting in New York.

10. Visited Alabama programs (four across the state) for one week.


11. Reviewed 40 journal articles and interviewed 12+ leaders regarding articulation, and reviewed 9 nursing curriculums.

12. Participated in state nursing articulation meetings and nursing issues task force (Albuquerque, NM).

13. Met with Campus Academic Officers regarding articulation (Las Cruces, NM).


14. Formulated questions for interviews regarding articulation.

15. Maintained contact with NMSU Carlsbad nursing program and NMSU regarding

issues and needs.

16. Completed reference list, handouts, slide presentation, and prepared for writing an article.

ISSUES: THE NURSING SHORTAGE1. Demand exceeds supply

• Average age of a practicing nurse is 45.2 years.

• Baby boomers will be retiring soon; most severely hurt will be nursing education.

• Increase in complexity and acuity of healthcare.• Expanding health care services and need for increased geriatric population with multiple chronic health issues.

ISSUES: THE NURSING SHORTAGE

2. Poor representation of minorities and men (10% represented); lack of nurse educators with advanced degrees.

3. • 58.4% practicing RN’s has less than a BSN.• 32% have a BSN, 9.1% are MSN prepared, 0.6% have a PhD.• Salaries for nursing educators are below

practicing RN salaries.


4. Changing nature of health care has caused a lengthy educational preparation (A.D.N. average is 3 years).

5. Increased complexity with concerns of quality patient care are indicative of need for better educated workforce.• Adequacy of nursing services is greatest

threat to the future of quality health care.


• Shortage of nurses results in closing hospital units, nursing home beds, etc.

• Push towards accountability and competencies.


6. Qualified nursing applicants are turned away citing limited classrooms, clinical sites, educators, and infrastructure despite increasing enrollment numbers to a crumbling system.


7. Need for cost efficiency, redesign care delivery system/satisfaction, competency base, differentiation of practice and increase funding/resources.

8. Segregated system-healthy private/public partnerships.

9. Perceived lack of transferability/mobility in nursing programs.

10. Lack of communication and networking of health professionals/educators.

How does NM compare in the nursing shortage and issues?

Average facility RN vacancy rate 30.6

Average LPN facility vacancy rate 0-50%

Majority of facilities do not differentiate pay for BSN

68.4% of health facilities indicated nursing staffing had impacted access to care


Average RN (ADN or BSN) salary: $58,856 (RN)and $41,427 (LPN)

■ Average MSN-ADN educators range from $38,633 - $50,000. Community RN pay is $71,500. 33% work 2nd job.

■ Average MSN/PhD-BSN or higher educators salary average $76,400. None work 2nd job.


Barriers to increasing enrollment cite lacking infrastructure- No permanent funding

- Poor recruitment and retention

- Limited clinical sites

- Poor or lacking facilities (clinical, classroom, lab)


NM is experiencing a more severe nursing shortage than the rest of the nation- Insufficient RN’s to meet demand

- Many RN’s will be retiring and this trend will continue through 2020

- Many RN’s in NM are 50 years old and older


Funding for nursing training is inadequate to meet the expected sharp increase in demand

Down 35% (1973-1990) in young females choosing nursing

NM average RN vacancy rate is projected at 10-24%

What has NM done to address the nursing shortage?

- 1999 NM Consortium for Nursing Workforce Development developed standards for differentiated practice comparisons.

- 2002 NM Nursing Shortage Statewide Strategy framework


PRIORITIES:

1. Double number of licensed nursing graduates in NM

- Nursing faculty shortage

- Improve clinical site rotations

- Expand enrollment in nursing programs


- Accelerate programs at attract students

- Seamless curriculum articulation

- Direct support to students

• Clinical teaching at institute

• Reduction in student attrition


2. Sustain this effort over the long term- Leadership- System wide communication- Data collection, analysis, forecasting- Goals of private/public partnerships- Statewide organization and infrastructure

• Center of Nursing Excellence• Strategies

Center of Nursing Excellence

Most recent reports:

- Vacancy and turnover in NM hospitals: Report of Survey (June 2007)

- Report of NM Education Survey (August 2007)

- Status of Nurses in NM (December 2007)

Legislative Support

Nonpermanent funding through HED for program improvement

Focus continues to be on enrollment numbers despite noted barriers noted previously

Nonpermanent nursing educator incentives

Scholarship funds for students

Nursing Articulation Task Force NM competencies

Vision/Barriers/Meetings

Nursing transfer module

Nursing matrix

“NM Schools of Nursing Articulation Plan”

Working with SBON and NM Center of Nursing Excellence

Do we have a seamless nursing curriculum?

History of articulation (national)

ANA position statement supporting competencies

Writers for 1st position paper on nursing education for nurses envisioned an orderly transition into nursing at two levels:

1) Professional 2) Technical


1965 ANA Barbara Scott “Nurses are wasting their time and energy debating over collegial education of tomorrow’s nurse.”

1966 ADN programs growth explosion with nursing shortage (940 ADN programs today;

600 in community colleges)


Secretary’s Commission on Nursing 1988 identified second shortage on demand side

- Lack of interest in nursingtoo demandingtoo undervaluedunrewardingpay

Basically issues of autonomy and financial culture of nursing education, the nature of nursing practice, and nursing supply 35 years after position statements note similarities between 1965 – 2000+

Failure to resolve workplace issues

Efforts to describe, quantify and address workforce issues & relationships to health care outcomes complex

Nurses lack satisfaction in their work

Unlicensed professionals included to meet needs

Nursing feelings of powerlessness, alienation

Types of Articulation

Mandated (8 states) – formal agreements exist as part of legislation & mandate credit transfer between nursing programs

Statewide Articulation Agreements (24 states) – voluntary articulation plans and models are developed through the collaborative efforts of nursing education, regulations, legislators, and other stakeholders.

Types of Articulation

Individual School to School Articulation Agreements (18 states) – Individual agreements between ADN/BSN programs delineating which nursing courses will transfer and maximum nursing credits accepted. No blanket agreements exist.

Within the NM region:

Statewide – Arizona Colorado (forerunners)

Mandated - Texas (basket curriculum numbering)

Individual - NM

Avenues to Licensure

1. Diploma2. ADN3. BSN4. Some MSN

Deeply imbedding in articulation is:- common competencies- differentiation of practice

Pro’s of Articulation

Clear expectations to students

No repeated material

Individual accreditation

Financial strength from collaboration


Students don’t repeat same courses when transferring, decreases time to reenter programs

Social justice for student (average 3 years to complete ADN)

Seamless system

Affordable


Equitable

Identifies changing student needs

Increase faculty sharing

Shows public/legislative coordination, sharing of resources & collaboration


Increases quality/assists new educators through increased communication/sharing

Can increase funding opportunities (state/federal)

Can start regional/system wide then progress.

Can use zip code for school tracking/data collection.


Each program can have own philosophy, concepts, delivery methods & class point assignments (academic freedom) “Above or below the line.”

Ease of ADN into BSN programs

Common trust & integrity fastened with all programs. Can assist weaker programs.


Can provide multiple entry/exit

Common competencies foster accountability, facilitate student expectations, promote quality of care

Opportunity to increase distance learning

Opportunity for high school dual enrollment (faculty career clusters)

Con’s of Articulation

Labor/time intensive

Requires commitment & multiple input

Average time is 2 years – 4 years to progressand 2 years to phase out old curriculum

■ Money & infrastructure must be strengthened


Continually needs collaboration, refinement, and support

Is not indicative of increasing number of enrollment or completion

Does not necessarily change barriers (i.e. clinical sites) to enrollment


Does not indicate increase in students transferring between programs

Unknown effect on quality programs (?)

Can limit innovation in curriculum to course progression

Average or slightly decreased pass rates have been noted

Requirements for Articulation

Infrastructure ■ Commitment

Funding ■ Partnerships

Communication ■ Faculty developed/owned

Collaboration ■ Trust/collegial respect

Recommendations

Strengthen partnerships between academic, service, government

Support new graduates

Common competencies/model – ID for continuing practice

Increase collaboration between program types

Recommendations

Implement recruitment activities at local levels emphasizing adult, minorities, men, young students

Efforts showed focus on communities we serve

Reallocate funds, reprioritize services, share resources, increase educational efficiencies

Recommendations

Define articulation, competencies & practice in NM

Include workforce issues recognition

Multiple stakeholders

Valuing nursing & contributions

Recommendations

Outcomes, data analysis, strategic planning

Evaluate needs & goals

Focus on long range effects

Multiple entry/exits to increase workforce numbers

Recommendations

Improve nursing faculty salaries & recruitment

Develop value neutral professional level language

PROCESS

Strategies for achieving articulation:

1. Convene a group of interested parties

- invitation initially

- frequent beginning meetings

- include nursing education, SBON, private sector, financial & student services, legislators, HED, Labor Dept., nursing executives, administrators

PROCESS

- invite outside consultants for prioritizing, attaining goals, values, mission, competency, review- utilize a competency focus rather than course comparisons- establish a formal NM Nursing Consortium to create progression & articulation

PROCESS

- identify assumptions, driving/restraining forces

- promote ownership through frequent communication

- acknowledge change is difficult

- keep goal of student welfare at the forefront

- don’t expect to develop a perfect plan

PROCESS

2. NM Nursing Consortium

- break into smaller committees

example:

1st year – fundamentals, maternal child, med surg, etc.

2nd year – med surg, psych, etc.

*option to integrate or course by topic

PROCESS

- develop core curriculum: 1 year/L.P.N, 2 years/A.D.N., 4 years/B.S.N.;

statewide curriculum; competencies; outcomes, course progression- develop competencies by semester to

serve as framework*option to divide clinical/didactic to increase enrollment, online distance learning options

PROCESS

- easy transferability and mobility

- focus to increase progression (i.e. credit hour escrow) of BSN education and advance degree education

- academic freedom is addressed in the implementation of the courses

PROCESS

- each school crafts own curriculum within common course numbers, instructor,

philosophy, credit hours, etc.

- control of excess classes/prerequisites decreasing time for completion

- standard grading policies, admission criteria

- coordination of financial aid

PROCESS

- increases support & communication amongst nurse educators

- yearly school/education experience with refinement of statewide curriculum

- quarterly meetings (via web, in person, by discipline of nurse educators

- curriculum could include materials to assist new educators

PROCESS

- class outlines, power point, etc.

- sharing of faculty, resources, SIM man exercises/scenarios

- sharing of faculty, resources, SIM man exercises/scenarios

- improved clinical site coordination

PROCESS

3. Promote health careers, support programs financially and clinical resources- marketing/recruitment- promote health concerns

• health career camps • school outreach • job shadow • school programs

PROCESS

4. Direct support to programs- $ schools- $ facilities- help develop new programs- support learners/students

• scholarships• tuition reimbursement/loan

forgiveness

PROCESS

- offering of classes on site facilities

- offer programs for current workers

PROCESS

5. Contribute to learning environment- clinical experience- building staff learning labs- pay clinical supervisor/providing clinical supervision- develop new clinical models

• nontraditional dates/times• clinical simulators

PROCESS

6. Develop consensus of competencies to serve as framework for education curriculum to create a seamless progression through all levels of nursing education

PROCESS

- develop statewide nurse internship/preceptor program

- phase 1: develop competencies

- phase 2: develop remaining program

- phase 3: develop remaining identified components

PROCESS

7. Appoint HED for nursing and allied health

- facilitation, support, & collaboration with nursing consortium, SBON, private sector, center for nursing excellence, universities/programs, legislation, etc.

Documents

Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing