Sabbatical Report: Statewide Nursing Articulation The Nursing Shortage

1
Sabbatical Report Statewide Nursing
ArticulationThe Nursing Shortage Nursing
Education Issues, Implications, Process and
Transformation

• Deanna Suggs, RN, MSN, FNPC
• NMSU Carlsbad Nursing Department
• Director/Professor of Nursing
• Fall 2007

2
SABBATICAL OBJECTIVES

• 1. 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.

3
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.

4
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.

5
SABBATICAL ACTIVITIES

• 1. 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.

6
SABBATICAL ACTIVITIES

• 5. 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.

7
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.

8
SABBATICAL ACTIVITIES

• 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).

9
SABBATICAL ACTIVITIES

• 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.

10
ISSUES THE NURSING SHORTAGE

• 1. 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.

11
ISSUES THE NURSING SHORTAGE

• 2. Poor representation of minorities and men (10
  represented) lack of nurse educators with
  advanced degrees.
• 3. 58.4 practicing RNs 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.

12
ISSUES THE NURSING SHORTAGE

• 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.

13
ISSUES THE NURSING SHORTAGE

• Shortage of nurses results in closing
  hospital units, nursing home beds, etc.
• Push towards accountability and competencies.

14
ISSUES THE NURSING SHORTAGE

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

15
ISSUES THE NURSING SHORTAGE

• 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.

16
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

17
How does NM compare in the nursing shortage and
issues?

• 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.

18
How does NM compare in the nursing shortage and
issues?

• Barriers to increasing enrollment cite lacking
  infrastructure
• - No permanent funding
• - Poor recruitment and retention
• - Limited clinical sites
• - Poor or lacking facilities (clinical,
  classroom, lab)

19
How does NM compare in the nursing shortage and
issues?

• NM is experiencing a more severe nursing shortage
  than the rest of the nation
• - Insufficient RNs to meet demand
• - Many RNs will be retiring and this trend will
  continue through 2020
• - Many RNs in NM are 50 years old and older

20
How does NM compare in the nursing shortage and
issues?

• 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

21
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

22
What has NM done to address the nursing shortage?

• PRIORITIES
• 1. Double number of licensed nursing graduates in
  NM
• - Nursing faculty shortage
• - Improve clinical site rotations
• - Expand enrollment in nursing programs

23
What has NM done to address the nursing shortage?

• - Accelerate programs at attract students
• - Seamless curriculum articulation
• - Direct support to students
• Clinical teaching at institute
• Reduction in student attrition

24
What has NM done to address the nursing shortage?

• 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

25
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)

26
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

27
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

28
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

29
Do we have a seamless nursing curriculum?

• 1965 ANA Barbara Scott Nurses are wasting their
  time and energy debating over collegial education
  of tomorrows nurse.
• 1966 ADN programs growth explosion with nursing
  shortage (940 ADN programs today
• 600 in community colleges)

30
Do we have a seamless nursing curriculum?

• Secretarys Commission on Nursing 1988
  identified second shortage on demand side
• - Lack of interest in nursing
• too demanding
• too undervalued
• unrewarding
• pay

31

• 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

32

• 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

33
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.

34
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.

35
Within the NM region

• Statewide Arizona
• Colorado (forerunners)
• Mandated - Texas (basket curriculum
  numbering)
• Individual - NM

36
Avenues to Licensure

• Diploma
• ADN
• BSN
• Some MSN
• Deeply imbedding in articulation is
• - common competencies
• - differentiation of practice

37
Pros of Articulation

• Clear expectations to students
• No repeated material
• Individual accreditation
• Financial strength from collaboration

38
Pros of Articulation

• Students dont repeat same courses when
  transferring, decreases time to reenter programs
• Social justice for student (average 3 years to
  complete ADN)
• Seamless system
• Affordable

39
Pros of Articulation

• Equitable
• Identifies changing student needs
• Increase faculty sharing
• Shows public/legislative coordination, sharing of
  resources collaboration

40
Pros of Articulation

• 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.

41
Pros of Articulation

• 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.

42
Pros of Articulation

• 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)

43
Cons of Articulation

• Labor/time intensive
• Requires commitment multiple input
• Average time is 2 years 4 years to progress
• and 2 years to phase out old curriculum
• Money infrastructure must be strengthened

44
Cons of Articulation

• 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

45
Cons of Articulation

• 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

46
Requirements for Articulation

• Infrastructure Commitment
• Funding Partnerships
• Communication Faculty developed/ owned
• Collaboration Trust/collegial respect

47
Recommendations

• Strengthen partnerships between academic,
  service, government
• Support new graduates
• Common competencies/model ID for continuing
  practice
• Increase collaboration between program types

48
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

49
Recommendations

• Define articulation, competencies practice in
  NM
• Include workforce issues recognition
• Multiple stakeholders
• Valuing nursing contributions

50
Recommendations

• Outcomes, data analysis, strategic planning
• Evaluate needs goals
• Focus on long range effects
• Multiple entry/exits to increase workforce numbers

51
Recommendations

• Improve nursing faculty salaries recruitment
• Develop value neutral professional level language

52
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

53
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

54
PROCESS

• - identify assumptions, driving/restraining
  forces
• - promote ownership through frequent
  communication
• - acknowledge change is difficult
• - keep goal of student welfare at the forefront
• - dont expect to develop a perfect plan

55
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

56
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

57
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

58
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

59
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

60
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

61
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

62
PROCESS

• Direct support to programs
• - schools
• - facilities
• - help develop new programs
• - support learners/students
• scholarships
• tuition reimbursement/loan
  forgiveness

63
PROCESS

• - offering of classes on site facilities
• - offer programs for current workers

64
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

65
PROCESS

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

66
PROCESS

• - develop statewide nurse internship/
• preceptor program
• - phase 1 develop competencies
• - phase 2 develop remaining program
• - phase 3 develop remaining identified
  components

67
PROCESS

• 7. Appoint HED for nursing and allied health
• - facilitation, support, collaboration with
  nursing consortium, SBON, private sector,
  center for nursing excellence, universities/progr
  ams, legislation, etc.

68
(No Transcript)