While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Experts project that the nation will face a shortage of more than a quarter of a million nurses by 2025—the result of a perfect storm of trends that include aging Baby Boomers’ growing need for care, the influx of millions of new patients due to health care reform, an expected wave of retirements from the profession, and difficulties in ramping up the capacity of nursing schools to graduate larger classes of nurses.
That last dynamic–nursing school capacity–is the principal subject of the most recent issue of Charting Nursing’s Future, the Robert Wood Johnson Foundation (RWJF) publication series focused on policy ideas with the potential to transform patient care. The new issue examines state-level partnerships that have created promising models and actual results.
The core problem is that tens of thousands of qualified applications to nursing programs are rejected each year because schools lack capacity. Their faculties may be too small, their pipelines to clinical placements may be insufficient or they may have other capacity deficits.
In 2008 and 2009, RWJF, the Center to Champion Nursing in America (CCNA), the U.S. Department of Labor and the U.S. Department of Health and Human Services’ Health Resources and Services Administration sponsored two national Nursing Education Capacity Summits. Representatives of 49 state partnerships participated in the two Summits, building coalitions and planning various activities. CCNA is now providing technical assistance to 30 of those partnerships, including the 12 whose stories are the substance of this latest issue of Charting Nursing’s Future.
State Partnerships in Action
The 12 state partnerships highlighted in the report include:
Texas. Facing a projected shortage of 70,000 nurses by 2019, leaders of the Texas Workforce Shortage Coalition set a goal to double the number of nursing graduates in the state by 2013, an objective they knew would require a three-fold increase in the state legislature’s appropriation to nursing school. The coalition expanded its membership to include business representatives, developed a pay-for-performance approach that would appeal to the legislature and mounted a statewide publicity campaign. The effort secured an additional $49.7 million for nursing education from the state.
Michigan. Strong leadership from Gov. Jennifer Granholm was key to Michigan’s work to attack its projected shortage of 18,000 nurses by 2015. The Governor created an Office of the Chief Nurse Executive to coordinate an effort that included $30 million in state funds for accelerated second-degree partnership programs bringing together schools, hospitals and state workforce collaboratives; the creation of the Michigan Nursing Corps to rapidly educate clinical and classroom faculty; and a new program for web-based management of clinical placements.
Virginia. In contrast to the Michigan approach, which relied on leadership from within state government, Virginia’s nursing leaders worked from the outside in, forming what came to be described as a “kitchen cabinet”–an informal network of nurses interested in public policy. Among the group’s challenges was healing splits among nursing organizations in the state and bringing the groups together on policy approaches. The effort played a key role in winning new scholarship appropriations from the legislature, as well as a 10-percent raise for nursing faculty in public colleges and universities that has in turn contributed to a 50-percent increase in the number of nursing graduates. It also helped ward off cuts in appropriations in a state that has steadily reduced its support for higher education in recent years.
New York/North Carolina. Two states not known for their commonalities, New York and North Carolina collaborated on a demonstration project called RIBN, pronounced “ribbon,” an acronym for Regionally Increasing Baccalaureate Nurses. The project paired community colleges and universities from New York City and rural North Carolina in an effort to marry the strengths of associate degree programs–large diverse classes, highly supportive learning environments and a focus on practical skills–with baccalaureate programs’ additional competencies and its position as a gateway to graduate education, to form pathways to BSN degrees. “RIBN is a role model for bridging the communication and expectation gaps between ADN and BSN programs—a way of turning a negative into a positive for patient care, nurses, students and faculty,” says Darlene Curley, executive director of New York’s Jonas Center for Nursing Excellence.
Florida. Nursing leaders at the Florida Center for Nursing (FCN) believe the key to expanding capacity is to develop accurate and powerful data about the status of nursing education capacity in the state. Toward that end, the organization secured Partners Investing in Nursing’s Future matching grants from RWJF and the Blue Foundation for a Healthy Florida and embarked on an intensive two-year analysis of the state’s use of simulation for new and practicing nurses. “You can’t expect state legislators to give you money to expand nursing education capacity unless you can say, ‘Here’s what we know about the nursing workforce,’” says Mary Lou Brunell, executive director of FCN.
North Dakota. Small, isolated rural communities are the rule, not the exception, in much of North Dakota, and providing nursing education in these areas is a particularly difficult challenge. Three efforts are making progress, however. The Dakota Nursing Program is a consortium of community colleges using a common curriculum, sharing administrative resources and faculty, and relying on such tech-oriented techniques as web-based instruction and mobile simulators. The state’s Nurse Faculty Intern Program is a pilot effort that allows BSN-RNs with two years of clinical experience to teach in nursing schools while pursuing advanced degrees. A third initiative, the Recruitment and Retention of American Indians into Nursing program or RAIN, offers scholarships, an expanded orientation for new nursing students, academic mentors, help with child care and transportation assistance.
A special supplement to the CNF issue highlights partnerships in five more states. They are:
Oregon. The Oregon Consortium for Nursing Education comprises eight community colleges and five Oregon Health and Science University campuses, partnering to share resources and use common admission standards, thus creating a seamless pathway from the ADN to and through BSN programs and increasing the number of baccalaureate-prepared nurses.
Massachusetts. The state has developed new core competencies to guide the standardization of the outcomes of education across a variety of institutions.
California. Regional collaborations have helped increase clinical placements, integrate more simulation into curricula and recruit and train new faculty.
Hawaii. Distance learning, web-based simulation and other innovative educational approaches have helped make up for faculty shortages and a lack of classroom space.
Mississippi. Detailed research zeroed in on drop-out rates among nursing students and identified a series of reasons, allowing nursing leaders to develop a variety of financial and family support tools to help keep students on the path to a nursing career.
Using a broad range of tailored approaches, these and other state-level partnerships are creating more effective advocacy for policy and regulatory change; redesigning educational programs by deploying revised curricula, new technology and updated clinical education models; and increasing faculty capacity and diversity.
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