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Sabbatical Report: Statewide Nursing Articulation The Nursing Shortage

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Title: 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
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