Academic Progression in Nursing: Wyoming Style
Mary E. Burman, PhD, FAANP, is dean and professor of nursing at the University of Wyoming (UW). She was a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow from 2007 to 2010 and coordinates a nurse education and leadership project that is supported by Partners Investing in Nursing’s Future (PIN), an initiative of RWJF and the Northwest Health Foundation.
Human Capital Blog: The Institute of Medicine (IOM) calls for a more highly educated nursing workforce and, in particular, for 80 percent of nurses to have bachelor’s degrees by 2020. What is the educational level of nurses in Wyoming? Do the state’s health care organizations prefer or require that nurses hold baccalaureate degrees?
Mary Burman: Wyoming, like many other states, and especially like many rural states, faces significant challenges in obtaining the IOM goal that 80 percent of nurses hold bachelor’s degrees by 2020. The Wyoming Center for Nursing and Health Care Partnerships (WCNHCP), home of the state’s nursing workforce center and Action Coalition, has developed estimates for the current number of nurses with baccalaureate degrees (BSN) and has made projections over the next four years.
We estimate that 36.9 percent of registered nurses (RNs) in Wyoming currently have baccalaureate or higher degrees. However, that percentage will not increase significantly over the next four years; in fact it may actually drop, given the number of new RNs with associate degrees in nursing (ADNs) and the number of nurses who are preparing to retire.
The number of younger nurses with BSNs rises consistently from now over the next four years because of increasing enrollments in UW’s RN-to-BSN program, which is very positive, but the overall percentage drops because of the relatively large number of ADN graduates. It is readily apparent from these analyses that without a significant increase in the number of ADN students continuing on for the BSN, Wyoming will have great difficulty obtaining the 80 percent BSN goal by 2020.
The demand for nurses with baccalaureate degrees is growing in Wyoming. The WCNHCP has partnered with a number of health care organizations, including a wide variety of employers from acute care to long-term care to outpatient care. The percentage of RNs with BSNs varies widely among these employers, from a low of 6 percent up to a high of 86 percent.
While most employers in the state offer incentives for nurses to advance their education, such as flex time and tuition reimbursement, few require the BSN at this point. However, given the work of Linda Aiken, PhD, RN, FAAN, and others linking nurse education levels with patient outcomes, a growing number are preferentially hiring nurses with BSNs and/or requiring or encouraging nurses prepared with associate degrees to complete BSNs within a specific period of time. A few employers do have a pay differential for nurses with BSNs.
HCB: What kind of barriers do nursing students and working nurses in your rural state face in achieving four-year nursing degrees?
Burman: Nursing students and working nurses face challenges returning to school given the rural nature of our state. Wyoming is a sparsely populated state, and much of it is rural or frontier. This impacts both the educational and health care systems in the state because it creates barriers to baccalaureate education. Many nurses and nursing students have difficulty accessing four-year programs because of distance, cost, insufficient opportunities for clinical educational experiences, and lack of employer-provided incentives.
There is only one baccalaureate program in nursing in the entire state; it is located at the sole 4-year public institution, the University of Wyoming. However, there are six community colleges offering associate degrees in nursing. Consequently, the number of new nurses with ADNs is significantly higher than those with BSNs. In 2011, there were 78 BSN graduates and 290 ADN graduates from Wyoming programs.
About 10 percent of graduates are continuing on to the BSN in Wyoming, at least through the RN-to-BSN completion program at UW. (We do not have data from other online schools.) Moreover, data show that ADN graduates in our state take an average of five years before enrolling in the BSN program at UW. That is somewhat lower than the national average of 7.5 years between ADN and BSN programs. Despite barriers, the number of students and graduates of UW’s RN-to-BSN completion program has grown significantly between 2007 and 2011, increasing from 104 students and 42 graduates in 2007 to 334 students and 73 graduates in 2011—almost a 100 percent increase in graduates in five years.
Our state’s hospitals and other clinical facilities are small; of the state’s 28 hospitals, 16 are critical access hospitals. This makes clinical education for nursing students using the traditional approach (with one faculty member for every eight students) challenging. Moreover, the models being discussed at the national level to transform nursing education, such as the dedicated education unit, are not easily adopted by the majority of clinical facilities in Wyoming because of their small sizes.
Compounding this is the fact that the majority of nurses working in clinical facilities in Wyoming hold ADNs, and there is a shortage of nurses with baccalaureate and graduate degrees. The traditional clinical education model taxes “faculty, facilities, students and staff, and increasingly relies on the availability of clinical placements” (Gubrud-Howe & Schoessler, 2008, pg. 3). This is particularly true in rural states like Wyoming and significantly affects the quality of and capacity for clinical education.
HCB: How are academic institutions in Wyoming working to help nursing students and working nurses overcome those barriers?
Burman: Currently, only about 10 percent of ADN graduates in Wyoming are continuing on to the BSN in Wyoming (at least through the RN-to-BSN completion program at UW), in comparison with 30 percent of ADN graduates in Oregon (Munkvold, Tanner, and Herinckx, 2012).
Wyoming has been working on streamlining the process of obtaining BSNs for nurses with associate degrees for almost a decade. These efforts began with a Health Resources and Services Administration grant to the Fay W. Whitney School of Nursing (FWWSON) at the UW called LEAP (Leadership Education to Advance Practice). It focused on recruitment, advising, and mentoring in the UW RN-to-BSN completion program in collaboration with Wyoming community colleges.
FWWSON has regular onsite advising for the RN-to-BSN students at four of the six community college programs and is working to expand onsite advising to all the colleges. FWWSON has also undertaken a variety of curricular and other redesigns to facilitate concurrent enrollment so that ADN students can be registered at a community college while taking pre-requisite courses at UW.
In addition, academic institutions have laid the groundwork for philanthropic engagement to support BSN education and work towards meeting the 80 percent BSN by 2020 goal. As part of an RWJF PIN grant, we have brought on more local, family, and community college foundations, such as the Newell B. Sargent Foundation and the Casper College Foundation.
In addition to new partners, philanthropic support for other educational efforts has developed. In 2007, Sheridan College received funding from the Whitney Benefits Foundation, a local foundation, to establish an endowed chair in the nursing program with the aim of increasing the number of nurses with a BSN. Through a memorandum of understanding with UW, the endowed chair teaches in the UW RN-to-BSN completion program and advises current ADN students and nurses with ADNs in northeastern Wyoming at Sheridan and Gillette Colleges in the Northern Wyoming Community College District. This has been very successful, resulting in a significant increase in the number of RN-to-BSN students from this area.
The McMurry Foundation has partnered with the FWWSON and the Wyoming Medical Center, one of Wyoming’s largest hospitals and a partner of the WCNHCP, to provide on-site recruitment and advising to motivate nurses to obtain their BSN degrees. In addition, the gift from the McMurry Foundation supports scholarships for students earning their BSNs at UW.
HCB: Can you describe the Revolutionizing Nurse Education in Wyoming program, known as ReNEW?
Burman: The ReNEW initiative seeks to enhance the quality of nursing and health care in Wyoming by building a stable, adequate nursing workforce. We propose achieving this goal through implementation of a common, competency-based statewide curriculum where students can start at any Wyoming community college or at UW and earn an associate degree or continue, seamlessly, towards a BSN degree (or higher).
The curricular redesign will ensure that nurses are knowledgeable, skilled, and capable of addressing the needs of the community. The initiative is closely aligned with the IOM 2010 report about the future of the nursing profession. In its report, the IOM recommends that “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.” It specifically recommends that the proportion of nurses with baccalaureate degrees be increased to 80 percent by 2020.
The aim of ReNEW is to enhance the quality of nursing and health care in Wyoming by revolutionizing nursing education. Its vision is to revolutionize nursing education by developing the following:
- A shared, competency-based statewide curriculum that allows students to earn an associate degree or continue on seamlessly to the BSN degree (or higher) starting at any of the community colleges or the University of Wyoming. The courses/clinical experiences needed to complete the BSN through the university will be available through distance delivery.
- Shared leadership through education and practice partnerships to co-create the nursing curriculum, optimize the use of clinical facilities and faculty throughout Wyoming, and shared education and clinical resources.
- A clinical education model focusing on enhancing clinical judgment, skill development, and professional nursing practice.
All six community college nursing programs and UW have signed a memorandum of understanding agreeing to participate as full partners in ReNEW. We’re on our way!