Advancing Nurse Education in North Carolina

    • May 16, 2014

For nursing students, the road from the associate’s to the bachelor’s degree can be rocky. But a program in North Carolina is smoothing out that path so more students are able to take it. In doing so, the program is creating a more highly educated—and more highly skilled—nursing workforce that is better able to provide care and promote health in the state.

The program, Regionally Increasing Baccalaureate Nurses (RIBN), has helped community and private colleges and universities in the state hammer out agreements that make it easier for nursing students in associate-degree programs to complete baccalaureate degrees at the beginning of their careers.

Student Success Advocates (SSAs) are a critical element of the program, says Polly Johnson, RN, MSN, FAAN, CEO of the Foundation for Nursing Excellence in Raleigh, N.C., and head of RIBN. SSAs are RIBN employees who work at the community colleges that participate in the program. They have backgrounds in areas such as nursing, education, and career counseling, and their role is to advise and advocate for students as they apply to the four-year RIBN program, and then monitor and support their progress. SSAs also raise awareness about the program and recruit applicants at career fairs and other events.

“Student Success Advocates are a key to the RIBN program’s success,” Johnson says. “Without them, I’m not sure we would have gotten very far out of the starting gate.”

Erin Luce, BSN, RN, an SSA in the southeastern part of the state, agrees. Many students would get lost without special guidance, she says. “It’s hard to find a go-between who can counsel a student about both associate-degree and university-level coursework. To have one person keeping track of everything at both schools is critical.”

Carol Douglas, BS/mathematics, an SSA in the western region of the state, echoes the sentiment. “SSAs are truly the go-to people for these students. We spend a lot of time making sure these students are on track to graduation and guide them during the first three years of the dual-enrollment program. Students know that they can come to us for support and guidance.”

Increasingly Complex Patients

More BSN-prepared nurses are needed to care for an increasingly complex patient population in a reformed health landscape, according to the future of nursing report issued by the Institute of Medicine in 2010. It recommended that 80 percent of the nation’s nurses hold BSN or higher degrees by 2020 to better care for a growing number of patients who are living longer, and sicker, with multiple chronic conditions. Nurses with more advanced education are also needed to serve as advanced practitioners, administrators and leaders, and as faculty members who can train the next generation of nurses and fill gaps in scientific research.

Associate degree students, however, often have difficulty moving into BSN programs, in part because educational requirements and policies differ across academic institutions, creating confusion, redundancy, and delay.

The cost of tuition can also be a barrier for associate-degree students, as can geography, since four-year nursing programs tend to be located in urban areas, which can pose access problems for nurses in more rural or remote areas.

In 2011, 55 percent of nurses in North Carolina entered practice with an associate’s degree, but only 17 percent of those nurses who started out with an associate’s degree had gone on to earn a higher degree, according to an article in the North Carolina Medical Journal. Moreover, many nurses with associate’s degrees wait until later in their careers to advance their education, limiting the time they can put their new knowledge to use.

The RIBN program seeks to knock down those barriers through a dual-admission enrollment process at community colleges and universities; seamless four-year curricula; and shared financial aid agreements. SSAs, meanwhile, guide students on their academic journeys.

Under the program, students are based at a community college for three years before moving to a university to complete the baccalaureate. Along the way, they achieve licensure as a registered nurse (RN) and have the option during the fourth year to work part-time as an RN. Students pay about $9,200 less in tuition than they would have at a traditional BSN program, and about $7,000 more than they would have had they stopped with an associate’s degree.

Eight regional partnerships are actively involved in the program, and another region plans to begin a RIBN program by 2015. In the fall of 2013, 190 students had enrolled in the RIBN track, and Johnson hopes that all qualified applicants in the state will eventually have the option of earning BSNs through the RIBN program. The plan is that by 2020, 55 of the state’s 59 associate-degree programs and 15 of its 21 universities with pre-licensure BSN programs will offer the RIBN track, Johnson says.

The program has received funding from Partners Investing in Nursing (PIN), a partnership of the Northwest Health Foundation and the Robert Wood Johnson Foundation (RWJF) to support the capacity, involvement, and leadership of local foundations to advance the nursing profession in their own communities. It has also received support from Academic Progression in Nursing, an RWJF-supported program that supports efforts to advance strategies aimed at creating a more highly educated workforce. Other organizations have also supported the project, including the Duke Endowment, which has contributed $1.3 million.

“It’s one of those wonderful win-win situations,” Johnson says. Students can earn BSNs more quickly and easily, giving them more skills and knowledge, and more marketable degrees, at significant savings. Community colleges continue to play an integral role in nurse education, and universities are able to expand RN-to-BSN programming. Employers, meanwhile, can more easily increase the proportion of BSN-prepared nurses, which has been associated with improved patient outcomes, and face lower tuition reimbursement expenses and reduced turnover.

Student Success Advocates say they like the program, and their jobs, too. “We are advocates not just for the program, but for the students,” says Mae Mills, BS, an SSA in the central part of the state. “We’re advocating for their success holistically, not just intellectually. It’s very much mind, body, and spirit. That’s why I love the program.”

Nursing students working on a mannequin during a class