A key recommendation from the landmark Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, calls for increasing the academic preparation of the nation's nursing workforce. Specifically, the report establishes two targets to be achieved by 2020: increasing the share of nurses in the workforce with baccalaureate degrees to 80 percent, and doubling the number of nurses with doctoral degrees.
The recommendation, the benefits and challenges of achieving it, and programs already in place to help make it a reality are the subject of the latest issue of Charting Nursing's Future, a series of policy briefs from the Robert Wood Johnson Foundation (RWJF). The 21st brief in the series, it examines trends in nursing education and employment, and highlights promising strategies for overcoming the barriers to nurses' academic progression.
At the outset, the brief sketches out the stakes. The nation already faces a nursing shortage and a primary care provider shortage, and the additional 32 million people who will soon have health insurance as a result of the Affordable Care Act will put an even greater strain on the system. As a result, identifying and implementing approaches that will expand the nursing workforce and prepare more nurses to provide primary care will be vitally important in the years ahead.
In addition, today's nurses are called on to join and lead interprofessional initiatives aimed at improving the quality, safety, and efficiency of care, and they often take the lead in care coordination and disease prevention. More education helps prepare them to meet these challenges.
A number of barriers stand in the way of nurses' academic progression, the brief points out. They include nurse faculty shortages that limit nursing schools' capacity, lack of coordination between degree programs in the same state, and the real-life difficulties that working nurses face returning to school to earn new degrees.
A number of approaches to facilitating nurses' academic progression are already at work, some supported by RWJF's Academic Progression in Nursing (APIN) initiative. APIN has focused its funding on four approaches that have already begun to show progress:
- Shared statewide or regional curricula;
- Shared frameworks for competency-based education;
- Conferring of community college baccalaureate degrees; and
- RN-to-MSN degree-completion programs.
The New Mexico Nursing Consortium, for example, has developed a common curriculum to be used at state nursing schools, allowing 100-percent transfer of nursing credits when students move from one institution to another. Not only does the approach facilitate student transfers, it allows community colleges and universities to form partnerships to deliver bachelor of science (BSN) courses at community colleges.
In Massachusetts, the nursing education and practice communities came together in 2006 to address the developing nursing shortage by creating a set of "Nurse of the Future Nursing Core Competencies," designed as a guide for nursing education and practice in the state. Such competency-based education approaches broaden students' focus from learning discrete skills to developing the ability to function as professionals. By applying them statewide, Massachusetts has helped smooth student transitions from one program to another.
In Florida and 18 other states, community college baccalaureate (CCB) degree programs allow nursing students to earn BSN degrees at nearby community colleges. Such programs are considered an affordable alternative to university-based programs, and they promote workforce diversity through more liberal admissions policies. Significantly, three-quarters of the students in Florida CCB programs are over the age of 24, suggesting that the programs do not compete with four-year institutions, whose students are usually much younger.
Another approach that is gaining traction is the RN-to-MSN degree completion program, a model that allows nurses with an associate degree or a hospital diploma to earn masters of science in nursing (MSN) degrees. Over the last 15 years, such programs have doubled in number across the United States, with 173 in operation today and more in development.
A fifth strategy that has shown great promise relies on employer-based incentives. Such programs create various "carrots and sticks" that encourage nurses to acquire BSNs. Northwestern Memorial Hospital in Chicago, for example, is working toward a 100-percent BSN-prepared nursing workforce by offering partial tuition reimbursement, scholarship support, and tuition discounts to its nurses who do not yet hold BSNs. Meanwhile, the hospital has adopted a BSN-only hiring policy.
Action Coalitions at Work
RWJF is backing many of these approaches through APIN as well as through support from the Future of Nursing: Campaign for Action, a collaboration between RWJF and AARP that has created Action Coalitions in all 50 states and the District of Columbia that are working to advance the IOM report's recommendations.
Read the Charting Nursing's Future brief, The Case for Academic Progression: Why Nurses Should Advance Their Education and the Strategies that Make this Feasible.