Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing
description
Transcript of Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing
Sabbatical Report: Statewide Nursing Articulation
The Nursing Shortage & Nursing Education:
Issues, Implications, Process and Transformation
Deanna Suggs, RN, MSN, FNPCNMSU Carlsbad Nursing Department
Director/Professor of NursingFall 2007
SABBATICAL OBJECTIVES1. Compare and contrast all unified statewide
nursing curriculum versus basket curriculums (states to evaluate: Texas, Alabama).
2. Discuss with NMSU nursing director, Allied Health Dean, and other stakeholders the goals and conceptualization of the curriculum desired for NMSU.
3. Identify methods to facilitate articulation between the 2-year A.D.N. and 4-year B.S.N. programs within the NMSU system.
SABBATICAL OBJECTIVES
4. Analyze the commonalities, key components, and difficulties associated with both forms of nursing curriculum.
5. Evaluate how funding and accreditation can be equitably addressed with each form of
curriculum.
6. Identify stakeholders to be involved in a nursing curriculum transition.
SABBATICAL OBJECTIVES
7. Estimate the number of students who successfully articulate with a unified form of nursing curriculum.
8. Propose a more seamless curriculum for the nursing programs of the NMSU system.
9. Possibility of submitting one journal article.
SABBATICAL ACTIVITIES1. Attended all NM State Board of Nursing
meetings (Albuquerque, NM).
2. Completed new NMSU Carlsbad Nursing Program Handbook.
3. Assisted in paramedic meetings/class.
4. Participated in radio show promoting NMSU Carlsbad and Nursing Program with Dr. Pearson.
SABBATICAL ACTIVITIES5. Attended NLN Nurse Educator Conference
and interviewed nurse leaders on articulation.
6. Attending meetings regarding clinicals in Texas.
7. Was appointed an NLN site visitor and attended training in Minneapolis.
SABBATICAL ACTIVITIES
8. Wrote HED report, met with Carlsbad Foundation, and wrote a quarterly report.
9. Appointed NLAC executive commissioner. Attended training and meeting in New York.
10. Visited Alabama programs (four across the state) for one week.
SABBATICAL ACTIVITIES
11. Reviewed 40 journal articles and interviewed 12+ leaders regarding articulation, and reviewed 9 nursing curriculums.
12. Participated in state nursing articulation meetings and nursing issues task force (Albuquerque, NM).
13. Met with Campus Academic Officers regarding articulation (Las Cruces, NM).
SABBATICAL ACTIVITIES
14. Formulated questions for interviews regarding articulation.
15. Maintained contact with NMSU Carlsbad nursing program and NMSU regarding
issues and needs.
16. Completed reference list, handouts, slide presentation, and prepared for writing an article.
ISSUES: THE NURSING SHORTAGE1. Demand exceeds supply
• Average age of a practicing nurse is 45.2 years.
• Baby boomers will be retiring soon; most severely hurt will be nursing education.
• Increase in complexity and acuity of healthcare.• Expanding health care services and need for increased geriatric population with multiple chronic health issues.
ISSUES: THE NURSING SHORTAGE
2. Poor representation of minorities and men (10% represented); lack of nurse educators with advanced degrees.
3. • 58.4% practicing RN’s has less than a BSN.• 32% have a BSN, 9.1% are MSN prepared, 0.6% have a PhD.• Salaries for nursing educators are below
practicing RN salaries.
ISSUES: THE NURSING SHORTAGE
4. Changing nature of health care has caused a lengthy educational preparation (A.D.N. average is 3 years).
5. Increased complexity with concerns of quality patient care are indicative of need for better educated workforce.• Adequacy of nursing services is greatest
threat to the future of quality health care.
ISSUES: THE NURSING SHORTAGE
• Shortage of nurses results in closing hospital units, nursing home beds, etc.
• Push towards accountability and competencies.
ISSUES: THE NURSING SHORTAGE
6. Qualified nursing applicants are turned away citing limited classrooms, clinical sites, educators, and infrastructure despite increasing enrollment numbers to a crumbling system.
ISSUES: THE NURSING SHORTAGE
7. Need for cost efficiency, redesign care delivery system/satisfaction, competency base, differentiation of practice and increase funding/resources.
8. Segregated system-healthy private/public partnerships.
9. Perceived lack of transferability/mobility in nursing programs.
10. Lack of communication and networking of health professionals/educators.
How does NM compare in the nursing shortage and issues?
Average facility RN vacancy rate 30.6
Average LPN facility vacancy rate 0-50%
Majority of facilities do not differentiate pay for BSN
68.4% of health facilities indicated nursing staffing had impacted access to care
How does NM compare in the nursing shortage and issues?
Average RN (ADN or BSN) salary: $58,856 (RN)and $41,427 (LPN)
■ Average MSN-ADN educators range from $38,633 - $50,000. Community RN pay is $71,500. 33% work 2nd job.
■ Average MSN/PhD-BSN or higher educators salary average $76,400. None work 2nd job.
How does NM compare in the nursing shortage and issues?
Barriers to increasing enrollment cite lacking infrastructure- No permanent funding
- Poor recruitment and retention
- Limited clinical sites
- Poor or lacking facilities (clinical, classroom, lab)
How does NM compare in the nursing shortage and issues?
NM is experiencing a more severe nursing shortage than the rest of the nation- Insufficient RN’s to meet demand
- Many RN’s will be retiring and this trend will continue through 2020
- Many RN’s in NM are 50 years old and older
How does NM compare in the nursing shortage and issues?
Funding for nursing training is inadequate to meet the expected sharp increase in demand
Down 35% (1973-1990) in young females choosing nursing
NM average RN vacancy rate is projected at 10-24%
What has NM done to address the nursing shortage?
- 1999 NM Consortium for Nursing Workforce Development developed standards for differentiated practice comparisons.
- 2002 NM Nursing Shortage Statewide Strategy framework
What has NM done to address the nursing shortage?
PRIORITIES:
1. Double number of licensed nursing graduates in NM
- Nursing faculty shortage
- Improve clinical site rotations
- Expand enrollment in nursing programs
What has NM done to address the nursing shortage?
- Accelerate programs at attract students
- Seamless curriculum articulation
- Direct support to students
• Clinical teaching at institute
• Reduction in student attrition
What has NM done to address the nursing shortage?
2. Sustain this effort over the long term- Leadership- System wide communication- Data collection, analysis, forecasting- Goals of private/public partnerships- Statewide organization and infrastructure
• Center of Nursing Excellence• Strategies
Center of Nursing Excellence
Most recent reports:
- Vacancy and turnover in NM hospitals: Report of Survey (June 2007)
- Report of NM Education Survey (August 2007)
- Status of Nurses in NM (December 2007)
Legislative Support
Nonpermanent funding through HED for program improvement
Focus continues to be on enrollment numbers despite noted barriers noted previously
Nonpermanent nursing educator incentives
Scholarship funds for students
Nursing Articulation Task Force NM competencies
Vision/Barriers/Meetings
Nursing transfer module
Nursing matrix
“NM Schools of Nursing Articulation Plan”
Working with SBON and NM Center of Nursing Excellence
Do we have a seamless nursing curriculum?
History of articulation (national)
ANA position statement supporting competencies
Writers for 1st position paper on nursing education for nurses envisioned an orderly transition into nursing at two levels:
1) Professional 2) Technical
Do we have a seamless nursing curriculum?
1965 ANA Barbara Scott “Nurses are wasting their time and energy debating over collegial education of tomorrow’s nurse.”
1966 ADN programs growth explosion with nursing shortage (940 ADN programs today;
600 in community colleges)
Do we have a seamless nursing curriculum?
Secretary’s Commission on Nursing 1988 identified second shortage on demand side
- Lack of interest in nursingtoo demandingtoo undervaluedunrewardingpay
Basically issues of autonomy and financial culture of nursing education, the nature of nursing practice, and nursing supply 35 years after position statements note similarities between 1965 – 2000+
Failure to resolve workplace issues
Efforts to describe, quantify and address workforce issues & relationships to health care outcomes complex
Nurses lack satisfaction in their work
Unlicensed professionals included to meet needs
Nursing feelings of powerlessness, alienation
Types of Articulation
Mandated (8 states) – formal agreements exist as part of legislation & mandate credit transfer between nursing programs
Statewide Articulation Agreements (24 states) – voluntary articulation plans and models are developed through the collaborative efforts of nursing education, regulations, legislators, and other stakeholders.
Types of Articulation
Individual School to School Articulation Agreements (18 states) – Individual agreements between ADN/BSN programs delineating which nursing courses will transfer and maximum nursing credits accepted. No blanket agreements exist.
Within the NM region:
Statewide – Arizona Colorado (forerunners)
Mandated - Texas (basket curriculum numbering)
Individual - NM
Avenues to Licensure
1. Diploma2. ADN3. BSN4. Some MSN
Deeply imbedding in articulation is:- common competencies- differentiation of practice
Pro’s of Articulation
Clear expectations to students
No repeated material
Individual accreditation
Financial strength from collaboration
Pro’s of Articulation
Students don’t repeat same courses when transferring, decreases time to reenter programs
Social justice for student (average 3 years to complete ADN)
Seamless system
Affordable
Pro’s of Articulation
Equitable
Identifies changing student needs
Increase faculty sharing
Shows public/legislative coordination, sharing of resources & collaboration
Pro’s of Articulation
Increases quality/assists new educators through increased communication/sharing
Can increase funding opportunities (state/federal)
Can start regional/system wide then progress.
Can use zip code for school tracking/data collection.
Pro’s of Articulation
Each program can have own philosophy, concepts, delivery methods & class point assignments (academic freedom) “Above or below the line.”
Ease of ADN into BSN programs
Common trust & integrity fastened with all programs. Can assist weaker programs.
Pro’s of Articulation
Can provide multiple entry/exit
Common competencies foster accountability, facilitate student expectations, promote quality of care
Opportunity to increase distance learning
Opportunity for high school dual enrollment (faculty career clusters)
Con’s of Articulation
Labor/time intensive
Requires commitment & multiple input
Average time is 2 years – 4 years to progressand 2 years to phase out old curriculum
■ Money & infrastructure must be strengthened
Con’s of Articulation
Continually needs collaboration, refinement, and support
Is not indicative of increasing number of enrollment or completion
Does not necessarily change barriers (i.e. clinical sites) to enrollment
Con’s of Articulation
Does not indicate increase in students transferring between programs
Unknown effect on quality programs (?)
Can limit innovation in curriculum to course progression
Average or slightly decreased pass rates have been noted
Requirements for Articulation
Infrastructure ■ Commitment
Funding ■ Partnerships
Communication ■ Faculty developed/owned
Collaboration ■ Trust/collegial respect
Recommendations
Strengthen partnerships between academic, service, government
Support new graduates
Common competencies/model – ID for continuing practice
Increase collaboration between program types
Recommendations
Implement recruitment activities at local levels emphasizing adult, minorities, men, young students
Efforts showed focus on communities we serve
Reallocate funds, reprioritize services, share resources, increase educational efficiencies
Recommendations
Define articulation, competencies & practice in NM
Include workforce issues recognition
Multiple stakeholders
Valuing nursing & contributions
Recommendations
Outcomes, data analysis, strategic planning
Evaluate needs & goals
Focus on long range effects
Multiple entry/exits to increase workforce numbers
Recommendations
Improve nursing faculty salaries & recruitment
Develop value neutral professional level language
PROCESS
Strategies for achieving articulation:
1. Convene a group of interested parties
- invitation initially
- frequent beginning meetings
- include nursing education, SBON, private sector, financial & student services, legislators, HED, Labor Dept., nursing executives, administrators
PROCESS
- invite outside consultants for prioritizing, attaining goals, values, mission, competency, review- utilize a competency focus rather than course comparisons- establish a formal NM Nursing Consortium to create progression & articulation
PROCESS
- identify assumptions, driving/restraining forces
- promote ownership through frequent communication
- acknowledge change is difficult
- keep goal of student welfare at the forefront
- don’t expect to develop a perfect plan
PROCESS
2. NM Nursing Consortium
- break into smaller committees
example:
1st year – fundamentals, maternal child, med surg, etc.
2nd year – med surg, psych, etc.
*option to integrate or course by topic
PROCESS
- develop core curriculum: 1 year/L.P.N, 2 years/A.D.N., 4 years/B.S.N.;
statewide curriculum; competencies; outcomes, course progression- develop competencies by semester to
serve as framework*option to divide clinical/didactic to increase enrollment, online distance learning options
PROCESS
- easy transferability and mobility
- focus to increase progression (i.e. credit hour escrow) of BSN education and advance degree education
- academic freedom is addressed in the implementation of the courses
PROCESS
- each school crafts own curriculum within common course numbers, instructor,
philosophy, credit hours, etc.
- control of excess classes/prerequisites decreasing time for completion
- standard grading policies, admission criteria
- coordination of financial aid
PROCESS
- increases support & communication amongst nurse educators
- yearly school/education experience with refinement of statewide curriculum
- quarterly meetings (via web, in person, by discipline of nurse educators
- curriculum could include materials to assist new educators
PROCESS
- class outlines, power point, etc.
- sharing of faculty, resources, SIM man exercises/scenarios
- sharing of faculty, resources, SIM man exercises/scenarios
- improved clinical site coordination
PROCESS
3. Promote health careers, support programs financially and clinical resources- marketing/recruitment- promote health concerns
• health career camps • school outreach • job shadow • school programs
PROCESS
4. Direct support to programs- $ schools- $ facilities- help develop new programs- support learners/students
• scholarships• tuition reimbursement/loan
forgiveness
PROCESS
- offering of classes on site facilities
- offer programs for current workers
PROCESS
5. Contribute to learning environment- clinical experience- building staff learning labs- pay clinical supervisor/providing clinical supervision- develop new clinical models
• nontraditional dates/times• clinical simulators
PROCESS
6. Develop consensus of competencies to serve as framework for education curriculum to create a seamless progression through all levels of nursing education
PROCESS
- develop statewide nurse internship/preceptor program
- phase 1: develop competencies
- phase 2: develop remaining program
- phase 3: develop remaining identified components
PROCESS
7. Appoint HED for nursing and allied health
- facilitation, support, & collaboration with nursing consortium, SBON, private sector, center for nursing excellence, universities/programs, legislation, etc.