March 2002

Grant Results

National Program

Ladders in Nursing Careers Program


North Dakota L.I.N.C. enrolled a total of 101 students in the program, who were spread across 47,000 square miles. To bring students and schools closer together, North Dakota L.I.N.C. used a variety of distance learning tools, including satellite, interactive video, correspondence courses, e-mail and itinerant professors.

Ladders in Nursing Careers (L.I.N.C.), a national grant program of the Robert Wood Johnson Foundation (RWJF), was a career advancement and health care work force education national program.

Key Results

  • Enrolled 22 Native American students; Native Americans represented just 1.7 percent of the state's nurses.
  • Became a state leader in distance learning.
  • Partnered with the University of North Dakota's Medstar program (a satellite system that delivers educational programming to the state's hospitals) and North Dakota Blue Cross/Blue Shield to provide students with access to the Internet and the University's library resources.
  • Collaborated with the University of North Dakota RAIN (Recruitment\Retention of Native Americans into Nursing) program, Northwest Technical College, and Little Hoop Community College (a tribal college) to bring a Licensed Practical Nursing (LPN) program to northeastern North Dakota via laptop computer.

RWJF provided two grant totaling $541,468 from February 1993 to June 1997 to support the project.

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North Dakota is a very rural state with a small, thinly spread population, a growing elderly population, and a relatively large proportion of Native Americans. Native Americans comprised 4.2 percent of the state's population but only 1.7 percent of the nursing population.

The need for a sustained supply of Native American nurses was growing as this population's desire and ability to offer health services within reservation boundaries increased. North Dakota's significant elderly population ranked it seventh among the states in 1990 in the percentage of residents age 65 or older.

The state saw an increase in its over-65 population of more than 13 percent from 1980 to 1990, and experienced an even greater increase in the oldest old — with the number of residents age 85 and above jumping by 38 percent. In 1990, about 60 percent of northwest North Dakota's population lived in rural areas with a population under 2,500 compared to 27 percent of the US population as a whole.

It was important for the state to find a sustained way of maintaining a cadre of nurses who came from and returned to rural areas to care for residents. Often the best way to bring nursing professionals to small, rural communities is to educate those who already work and live there.

Project L.I.N.C. was viewed as an ideal vehicle to do this. North Dakota's geography and population figured heavily in the design of most programs brought into the state. A number of health care facilities are located in rural areas, often vast distances from educational institutions. Therefore, distance education modalities are required in order to bring educational opportunities to the students and minimize the amount of time spent commuting to classes.

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The North Dakota Hospital Association implemented Project L.I.N.C. in the western two-thirds of the state. Because of the state's small population, the key players — representatives from the schools, health care facilities, regulatory agencies, and other pertinent associations — were known to one another and willing to support the goals of Project L.I.N.C.

All told, Project L.I.N.C. served 33 facilities, including 11 hospitals and 17 long-term care facilities. Thee participating facilities contributed a total of $506,816 in subsidies to L.I.N.C. students' education.

North Dakota Project L.I.N.C.'s objectives included:

  • Increase the number of locally available nurses to health care facilities in North Dakota, beginning with the western two-thirds of the state.
  • Make educational programs accessible to students in remote areas.
  • Offer social and academic support to L.I.N.C. students as necessary to meet their individual needs.
  • Involve participating facilities in the recruitment and support of L.I.N.C. students and in the successful implementation of the project.
  • Enroll Native American students in order to increase the number of Native American nurses to more closely reflect population demographics in the state.

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North Dakota L.I.N.C. enrolled a total of 101 students in the program: 57 LPN students, 41 RN students, and 3 BSN completion students. Twenty-two (22) of these students were Native Americans. Native Americans represent 4.2 percent of the total population in the state and only 1.7 percent of the state's nurses.

By December 1997, 42 of the 101 enrolled students had graduated. Because the nursing shortage remained acute in North Dakota, the site did not shift its attention to also developing allied health professionals to meet work force demand.

Project L.I.N.C. facilitated the development of a wide range of distance technologies to bring students and schools together. With the goal of bringing 80 percent of the course work to within 40 miles of the local communities in which Project L.I.N.C. students lived, North Dakota L.I.N.C. took the state a giant step forward from where it had been in 1994 — when only interactive video and traditional correspondence courses were used. The complete list of distance modalities employed to bring educational to L.I.N.C. students includes:

  • Interactive video.
  • Interactive video paired with correspondence course work.
  • E-mail assisted course work.
  • Desktop conferencing.
  • Traditional correspondence.
  • Traditional correspondence paired with on-site instruction.
  • Alternative block scheduling (scheduling classes in time blocks allowing students to travel to campus one time per week rather than five).
  • Itinerant professors.
  • Itinerant professors paired with videotaped classes and local test proctoring.
  • Itinerant professors paired with laptop computer-assisted instruction.
  • Use of local facilities for clinical experience whenever possible.
  • Use of local clinical instructors paired with itinerant nursing faculty.

L.I.N.C. became a state leader in distance learning — assisting schools and students to utilize technology to increase access to nursing education. To do so, North Dakota Project L.I.N.C. overcame turf barriers to adopting distance education technology, linking students to specific schools, and allocating financial aid resources to non-traditional students taking courses at more than one nursing program.

It also employed 11 field consultants strategically distributed throughout the state who monitored L.I.N.C. students' progress, arranged tutoring, assisted students in negotiating complicated college registration and financial aid procedures, and provided a liaison between students and between students and employers.

North Dakota Project L.I.N.C. partnered with the University of North Dakota's Medstar program (a satellite system that delivers educational programming to the state's hospitals) and North Dakota Blue Cross/Blue Shield to provide students with access to the Internet and the University's library resources. The Medstar program provided students access to computers in rural medical facilities throughout the state.

Connections to the Internet (at no cost) were established using Blue Cross/Blue Shield's network. E-mail accounts were established for the students to provide electronic access to faculty. North Dakota L.I.N.C. also developed its own Web site which provided "point and click" access to valuable Internet sites, including medical research libraries and nursing journals. Instructional videotapes were developed and disseminated to students to help them understand and effectively use these electronic resources.

North Dakota Project L.I.N.C. collaborated with the UND RAIN program, Northwest Technical College, and Little Hoop Community College (a tribal college) to bring an LPN program to northeastern North Dakota via laptop computer. Students were enrolled and issued laptop computers in June 1997. The area had been without an LPN education program for thirteen years.

In attempting to meet its objective to enroll significant numbers of Native American students, North Dakota L.I.N.C. faced difficulties. A two-pronged approached was used to facilitate recruitment: L.I.N.C. enrolled students who were not supported by individual facilities (obtaining permission from the National Program Office to make this change) and partnered with RAIN. L.I.N.C.'s affiliation with RAIN gave it credibility within the Native American community and provided an entré to the Spirit Lake Sioux tribal population and the Little Hoop Community College.

In addition to RWJF funding, North Dakota L.I.N.C. secured nearly $640,000 in grants and donations, with large contributions coming from North Dakota Blue Cross/Blue Shield, the Otto Bremer Foundation, and the Northwest Area Coalition.


North Dakota Project L.I.N.C. created three videotapes to help students learn how to use computer software, such as Windows 95, and the Internet. See the Bibliography for details.

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North Dakota Project L.I.N.C. planned to continue its work after RWJF funding, relying on remaining grant dollars from other sources as well as future grant dollars that would be obtained through ongoing fundraising efforts. When the grant ended in June 1997, North Dakota Project L.I.N.C. estimated that it had sufficient dollars to support students through June 1998.

Future student enrollment plans for North Dakota Project L.I.N.C. were undecided as of the program's July 31, 1997 final report. North Dakota Project L.I.N.C. was considering conducting a "needs assessment regarding the project's value among members" to determine whether to continue the program or phase it out.

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North Dakota Project L.I.N.C.


North Dakota Hospital Research and Education Foundation (Bismarck,  ND)

  • Amount: $ 42,068
    Dates: February 1993 to January 1994
    ID#:  021762

  • Amount: $ 499,400
    Dates: January 1994 to June 1997
    ID#:  023382


Shireen Holloway-Hoff
(701) 838-8062

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(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Audio-Visuals and Computer Software

Introducing the Internet (videotape). Gilby, N.D.: Larson Consulting Group, 1997.

Editing HTML Documents (videotape). Gilby, N.D.: Larson Consulting Group, 1997.

Using Windows 95 (videotape). Gilby, N.D.: Larson Consulting Group, 1997.

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Report prepared by: Karin Gillespie
Reviewed by: Patricia Patrizi
Reviewed by: Molly McKaughan
Original Program Officer: Polly M. Seitz
Current Program Officer: Rosemary Gibson

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