Strategies to Increase the Number of Initial Licensure Registered Nurses and Nursing Faculty

Strategies to Increase the

Number of Initial

Licensure Registered

Nurses and Nursing

Faculty

A Report to the 81st Texas Legislature January 2009

Texas Higher Education Coordinating Board

Accountability


A.W. “Whit” Riter III, CHAIR Tyler

Fred W. Heldenfels IV, VICE CHAIR Austin

Elaine Mendoza, SECRETARY OF THE BOARD San Antonio

Charles “Trey” Lewis III, STUDENT REPRESENTATIVE Houston

Laurie Bricker Houston

Joe B. Hinton Crawford

Brenda Pejovich Dallas

Lyn Bracewell Phillips Bastrop

Robert W. Shepard Harlingen

Robert V. Wingo El Paso

Raymund A. Paredes, COMMISSIONER OF HIGHER EDUCATION

Mission of the Coordinating Board

The Texas Higher Education Coordinating Board‟s mission is to work with the

Legislature, Governor, governing boards, higher education institutions and other entities

to help Texas meet the goals of the state‟s higher education plan, Closing the Gaps by

2015, and thereby provide the people of Texas the widest access to higher education of

the highest quality in the most efficient manner.

Philosophy of the Coordinating Board

The Texas Higher Education Coordinating Board will promote access to quality higher

education across the state with the conviction that access without quality is mediocrity

and that quality without access is unacceptable. The Board will be open, ethical,

responsive, and committed to public service. The Board will approach its work with a

sense of purpose and responsibility to the people of Texas and is committed to the best

use of public monies. The Coordinating Board will engage in actions that add value to

Texas and to higher education. The agency will avoid efforts that do not add value or

that are duplicated by other entities.

The Texas Higher Education Coordinating Board does not discriminate on the basis of race, color, national origin, gender,

religion, age, or disability in employment or the provision of services.

i

Executive Summary

This report summarizes the state‟s efforts to prepare students for initial licensure as registered nurses. It offers strategies for increasing both enrollments and graduation rates in initial licensure programs and the number of nursing faculty to teach in these programs. The primary goal of these efforts is to reach the statewide projections for new initial licensure graduates set by the Texas Center for Nursing Workforce Studies.

In discussing strategies for increasing the number of initial licensure graduates and nursing faculty, this report also complements two other reports prepared for the 81st Texas Legislature. A New Curriculum Model for Initial RN Licensure Program (October 2008) and The Feasibility of Sharing Basic Health Science Courses in Health Education Programs (July 2008) presents strategies for promoting efficiencies in the state‟s nursing programs and improving the quality of initial licensure education. The executive summaries for both reports are included as Appendices B and C.

The data and analyses in this report are divided into six sections: Initial Licensure Education, Graduate Education and Potential Nursing Faculty, Initial Licensure Nursing Faculty, Practitioner and Practice Trends, Strategies for Increasing the Number of Graduates in Nursing Education, and Summary of Key Findings and Recommendations.

Key Findings

Initial Licensure Education

Since 1998, initial licensure programs have increased significantly in applications (124 percent), first-year enrollments (133 percent), and total enrollments (52 percent). Since 2001, initial licensure graduates have increased by 55 percent.

To keep up with the demand for new registered nurses, the state‟s nursing programs will need to double the number of initial licensure graduates (approximately 14,600) by 2012 and nearly double that number again (approximately 24,900) by 2020.

From 2001 to 2007, only two of the state‟s initial licensure programs increased the number of graduates in each of those six years, and only 13 programs had net increases of 50 graduates or more during this six-year period. Due to these variations across programs, institutions may benefit from having established graduation targets.

In 2007, the statewide graduation rate for one-year and two-year initial licensure programs was 69 percent. The statewide rate varied widely by institution from 22 percent to 98 percent. Programs at health-related institutions had the highest overall graduation rates (86 percent), followed by those at universities (72 percent) and community colleges (66 percent).

ii

Graduate Education and Potential Nursing Faculty

Since 2003, the total enrollment of graduate nursing students has increased by 56 percent, peaking in 2007 at 3,837.

From 2003-2007, the number of graduates from Master of Science in Nursing (MSN) programs increased by 96 percent. Doctoral graduates increased by 76 percent during the same time period.

Despite the increased enrollment in graduate nursing programs, the shortage of nursing faculty remains a significant concern for the state.

Master‟s Programs

Since 2003, there has been a steady increase in the total enrollment of master‟s students (51 percent) with the most significant increase occurring with nursing educator program enrollment (141 percent).

Graduates from master‟s nursing programs have increased significantly with nursing educator having the highest increase (493 percent) of all master‟s nursing programs. However, for 2007, less than 10 percent of all master‟s level graduates were from nursing educator programs.

There are currently 18 MSN degree programs that prepare nursing educators. Post-master‟s nursing educator certificate program options are offered at seven institutions. These certificate programs offer courses in curricular and instructional design for master‟s-prepared nurses whose graduate preparation is in another specialization area, such as advanced practice nursing.

Doctoral Programs

In 2008, the first-year entering enrollment in Doctor of Philosophy in Nursing (Ph.D.) programs was the lowest in the last six years. This decrease may be attributed to the Doctor of Nursing Practice (DNP), the new professional doctoral program for advanced practice nurses. Since 2006, seven DNP programs have been established in Texas, in addition to the seven Ph.D. programs. From 2007 to 2008, DNP total student enrollment increased by 625 percent.

Initial Licensure Faculty

The average age of all nursing faculty is 53 years. Approximately 66 percent of nursing faculty are eligible to retire within the next 12 years.

With nursing faculty salaries well below those for master‟s-prepared nurses in practice, recruiting new faculty from practice will be difficult.

To expand on the success of the existing Professional Nursing Shortage Reduction Program, Texas Higher Education Coordinating Board (THECB) requested an additional $10 million for the

iii

2010-11 biennium. The request also proposed an amendment to the appropriation rider to allow funds to be used for stipends for future nurse educators.

Practitioner and Practice Trends

Only a small portion of nurses are qualified to be faculty in initial licensure programs. Less than 12 percent of all Texas nurses have graduate degrees.

The state has fewer nurses per 100,000 population than eight of the 10 most populous states

and the 2004 national average.

The Upper Rio Grande and South Texas regions (excluding Bexar county) have the fewest nurses per 100,000 population.

Recommendations The THECB recommends the following strategies or actions to increase the number of nursing

graduates from Texas institutions:

The THECB should establish institution-specific graduation targets for initial licensure programs in the state‟s Higher Education Accountability Systems for community colleges, universities, and health-related institutions.

To improve graduation rates, the Texas Legislature could provide incentive funding for those nursing programs that achieve an 85 percent or higher graduation rate or that have made significant progress toward the 85 percent graduation rate.

The Texas Legislature could provide funding for the existing Graduate Nurses‟ Loan Repayment Program. The funds would repay the student loans of graduates from MSN in nursing educator programs and Ph.D. in nursing programs at a cost of $7,000 per year for each student.

The Texas Legislature should increase funding for the Professional Nursing Shortage Reduction Program by $10 million and amend the Program‟s appropriation rider to allow eligible institutions to use the funds to pay stipends to graduate students who enroll in nurse educator degree or certificate programs.

Acknowledgements The THECB gratefully acknowledges the contributions of the staffs of the Texas Board of Nursing and Texas Center for Nursing Workforce Studies in the production of this report. We would also like to thank our consultants on this report: Andrea Lindell, Ph.D., RN, ANEF, dean of the College of Nursing and associate senior vice president for academic health affairs at the University of Cincinnati, and Nancy Spector, Ph.D., RN, director of education at the National Council of State Boards of Nursing. We are also grateful to Elizabeth Mayer, a research associate, and Alfredo Obregón, a higher education intern, for their work on this report.

v

Table of Contents

Introduction ............................................................................................................ 1

I. Initial Licensure Education ............................................................................. 6

A. Schools with Initial Licensure Programs .............................................. 7 B. Student Data for Initial Licensure Programs.......................................... 8

II. Graduate Education and Potential Faculty ...................................................... 20

A. Student Data for All Graduate Programs .............................................. 22 B. Master of Science in Nursing Programs ............................................... 25 C. Doctoral Programs ............................................................................ 29

III. Initial Licensure Nursing Faculty .................................................................... 35

IV. Practitioner and Practice Trends .................................................................... 38

V. Strategies for Increasing Capacity and Student Success in Nursing Education ................................................................................................. 42

A. Initial Licensure Education ................................................................. 42 B. Graduate Education and Potential Nursing Faculty ............................... 44 C. Initial Licensure Nursing Faculty ......................................................... 44

VI. Summary of Key Findings and Recommendations ........................................... 45

Data Sources ......................................................................................................... 48

Appendices

vi

Appendices

A Status of Key Recommendations from Previous THECB Reports on Initial Licensure Nursing Programs and Nursing Faculty

B Executive Summary of A New Curriculum Model for Initial RN Licensure Programs

(October 2008)

C Executive Summary of The Feasibility of Sharing Basic Health Science Courses in Health Education Programs (July 2008)

D Institutions Offering Initial Licensure Programs (As of October 2008)

E Additional Maps Showing the Location of Specific Types of Initial Licensure Programs

F 2007 Graduation Rates by Initial Licensure Program

G Six-Year Graduation Trend Analysis By Initial Licensure Program

H Detailed Educational Pipeline by Degree Level

I Institutions Offering Master of Science in Nursing by Program Type

J Institutions That Submitted Incomplete or No Data for Graduate Programs

K Practice Salary Data by Job Title and Texas Location (2008)

L Projects Funded under the 2008-09 Nursing, Allied Heath, and Other Health Education Grant Program

1

Introduction Background

Nurses are often referred to as the “backbone” of health care in the United States. They are frequently the most visible practitioners in a hospital, school, home, or long-term care facility, focusing not only on a particular health problem but also on the whole patient and the needs of her or his family. Registered nurses (hereafter referred to as „nurses‟ or „Texas nurses‟), those individuals who have earned at least a three-year diploma, two-year associate‟s degree, or a four-year baccalaureate degree in nursing, constitute the largest health care occupation, holding 2.5 million jobs in the United States.1 As of May 2007, Texas had 155,858 nurses (approximately 6 percent of the national total) residing and practicing in the state.

In recent years, Texas, like many states, has experienced a well-publicized nursing shortage that is different from shortages of the past and, therefore, may have a more long-term impact on the availability and quality of health care delivery. In the past, nursing shortages have been caused primarily by market factors such as levels of health care reimbursement. The current shortage is driven primarily by demographic changes. General population growth, the rising proportion of people over age 65, and advances in medical technology are expected to greatly accelerate the future demand for patient care services and, thus, the need for new nurses. As a result of these factors, the U.S. Department of Labor has identified nursing as the top occupation in the country for an increase in employment through the year 2016. This means that more new jobs are expected to be created for nurses than for any other occupation. And while other health care occupations, particularly those in allied health fields, show higher rates of job growth in Texas, the sheer number of nurses needed to fill new and replacement positions in Texas makes nursing education an important issue for the state. The THECB has determined that increasing the number of nurses is of sufficient importance to make it a specific target for success in Closing The Gaps by 2015, The Texas Higher Education Plan.

The Projected Need for New Initial Licensure Graduates in Texas

In recent years, the Texas Center for Nursing Workforce Studies, a unit of the Texas Department of State Health Services, has built a sophisticated data collection system to document the current and future need for graduates from initial RN licensure programs (hereafter referred to as initial licensure programs). In 2006, the Center made its first projections of the number of new initial licensure graduates needed in the state, using a supply-demand model developed by the U.S. Health Resources and Services Administration. This original table has been recently updated by the THECB to reflect new projections of graduates based on the number of initial licensure graduates reported from 2002 through 2007:

1 Source: U.S. Department of Labor, 2008.

2

The data show that from 2007 to 2012, the state will need to double the number of initial licensure nursing graduates to begin to meet the need for new nurses. By 2020, that 2012 number will need to almost double again.

Initial and Future Responses to Projections

To achieve short-term projections, Texas has concentrated much of its efforts on building enrollment capacity and improving student graduation rates in the state‟s 94 initial licensure programs. To increase capacity and improve graduation rates in these programs, the state must also produce more nursing faculty from its master‟s and doctoral programs or recruit master‟s or doctorally prepared nurses from practice. A chart showing the progression of nursing education from initial licensure graduate to doctoral graduate appears on pages 4 and 5.

In an effort to achieve long term projections, key supporters of nursing, such as the Robert Wood Johnson Foundation and the U.S. Department of Labor, are encouraging nursing programs to increase enrollments and improve graduation rates through greater efficiencies in nursing education. Those efficiencies would change how students are taught and how instruction is delivered by leveraging scarce resources, such as faculty and instructional technology, among existing nursing programs.

YearBaseline Supply of

Graduates*

Total Supply of RN

Graduates

Needed**

Additional Number of

Graduates Needed

2007 7,031 N/A N/A

2008 7,553 N/A N/A

2009 8,031 N/A N/A

2010 8,510 9,717 1,207

2011 8,989 12,065 3,076

2012 9,468 14,593 5,125

2013 9,946 15,199 5,253

2014 10,425 17,117 6,692

2015 10,904 17,777 6,873

2016 11,382 19,383 8,001

2017 11,861 20,073 8,212

2018 12,340 23,302 10,962

2019 12,819 24,085 11,266

2020 13,297 24,870 11,573

Sources: Texas Center for Nursing Workforce Studies and Coordinating Board.

**U.S. Health Resources and Services Administration, Supply Model.

Projected Need for New Initial Licensure Graduates in Texas

(2007-2020)

*Numbers are based on a simple regression formula of actual graduation data reported from 2002 to 2007.

Graduation numbers do not include those from programs that have not yet produced graduates as of 2007.

3

Focus and Organization of this Report

This report summarizes the progress of the state‟s initial licensure programs to relieve the state‟s near-term nursing shortage and to offer other strategies for increasing enrollments and graduates from those programs. It also updates selected information presented in the THECB‟s previous legislative reports: Increasing Capacity and Efficiency in Programs Leading to Initial RN Licensure in Texas (2004); and Strategies to Increase the Number of Graduates from Initial RN Licensure Programs (2006). The status of key recommendations from those two reports is included in Appendix A.

The report also supplements two recent reports prepared for the 81st Texas Legislature that present long-term strategies that promote a new curriculum model for nursing education and other efficiencies in the state‟s initial licensure programs. The executive summaries for those reports, A New Curriculum Model for Initial RN Licensure Program (October 2008) and The Feasibility of Sharing Basic Health Science Courses in Health Education Programs (July 2008) are included as Appendices B and C.

The data and analyses in this report are divided into six sections: Initial Licensure Education, Graduate Education and Potential Faculty, Initial Licensure Nursing Faculty, Practitioner and Practice Trends, Strategies for Increasing the Number of Graduates in Nursing Education, and Summary of Key Findings and Recommendations.

COMMON EDUCATION PATHWAYS FOR TEXAS REGISTERED NURSES (RNs)

High School Graduates take the Recommended

High School Curriculum

University or

Hospital-Based Community Colleges Health-Related Institution

Transition Accelerated & Associate

Diploma Program Bachelor‟s Degree (ADN) Alternate

3 years (LVN to ADN) Degree (BSN) 2 years Entry Program

1 year 4 years 1-2 years

RN Licensure Exam

Practice as

Registered Nurse

LVN: Licensed Vocational Nursing Program

ADN: Associate Degree Nursing Program BSN: Bachelor of Science Degree Nursing Program

4

5

COMMON PATHWAYS FOR GRADUATE NURSING EDUCATION IN TEXAS

*Currently Texas Tech University Health Sciences Center has the only Doctor of Nursing Practice program that admits students who are not Advanced Practice Nurses.

Master of Science in Nursing (MSN)

2-3 years

Advanced Practice Nursing - Nurse Midwife - Nurse Practitioner - Nurse Anesthetist - Clinical Nurse Specialist

- Nurse Educator - Nurse Administrator - Public Health Nurse

*Doctor of Nursing Practice

2-3 additional years

Doctor of Philosophy in Nursing (Ph.D.)

3+ additional years

6

I. Initial Licensure Education

This section presents specific data and issues related to initial licensure programs, defined as education programs that prepare students for initial licensure as registered nurses.

Texas has five major types of initial licensure programs:

Diploma programs are traditionally hospital-based and require three years of study.

Licensed vocational nursing to registered nurse programs (LVN-RN) traditionally requires one year of study after a student has completed a certificate program and is licensed as vocational nurse (LVN). The LVN then completes a curriculum leading to licensure as a registered nurse. Most of the LVN-RN programs are offered as LVN-ADN programs at community colleges, and program completers are reported as ADN graduates.

Associate degree programs (ADN) traditionally require prerequisites (i.e., anatomy and physiology) plus two years of study at a community college.

Baccalaureate degree programs (BSN) traditionally require four years of study with nursing curricula usually occurring during the last two years at a university or health-related institution.

Alternate entry degree programs are normally accelerated, second-degree programs and are usually offered at a university or health-related institution.

Graduates from these different programs take the same national licensure exam and often earn the same starting salary at health care facilities.

The following table shows the distribution of these types of programs as of September 2008 and the percentage of degrees conferred in 2007:

Initial Licensure Programs In Texas (2007, 2008)

Type of Program Number of Programs * Percentage of 2007 Graduates **

Diploma 2 2.5%

Associate Degree (ADN) 62 59%

Baccalaureate Degree (BSN) 29 38%

Alternate Entry Master‟s Degree 1 0.5%

Total Programs 94 100 % Sources: Texas Center for Nursing Workforce Studies and the Texas Board of Nursing.

* “Number of Programs” represents the most current number of initial licensure programs approved by the Texas Board of

Nursing as of September 2008. Not all of the new programs produced graduates in 2007. ** “Percentage of 2007 Graduates” represents the percentage of students who graduated from each type of the state‟s 86 initial

licensure programs in 2007. The 86 programs reported a total of 7,031 graduates.

A. Schools with Initial Licensure Programs

Initial Licensure Programs by Region (2008)

Baccalaureate Total Associate Degree

Regions Diploma Degree Nursing Programs Nursing Programs

Programs*High Plains 5 1 2 2

Northwest 6 0 4 2

Metroplex 14 0 9 5

Upper East Texas 8 0 6 2

Southeast Texas 7 0 5 2

Gulf Coast 20 0 15 5

Central Texas 12 0 6 6

South Texas 17 1 10 6

West Texas 4 0 4 0

Upper Rio Grande 2 0 1 1

Total 95 2 62 31

Source: Texas Board of Nursing and Coordinating Board.

*Texas Woman's University is counted twice to include separate programs in Houston and in Dallas.

For a list of the institutions with initial licensure programs, see Appendix D. For additional maps by specific type of degree program, see Appendix E.

7

8

B. Student Data for Initial Licensure Programs 1. Applications From 1998 to 2007, the number of applications increased by 124 percent. In 2007, applications declined for the first time during this period, although offers of admission continued to increase (see next page).

8,510 8,004

11,02111,646

12,253

15,166

22,325 22,39322,885

19,035

5,654 5,324

7,027 7,322 7,571

9,504

13,961 13,861 14,090

11,419

2,856 2,6803,994

4,324 4,6825,662

8,3648,532 8,795

7,616

0

5,000

10,000

15,000

20,000

25,000

1998* 1999* 2000* 2001 2002 2003 2004 2005 2006 2007

Total Qualified Applications (Duplicated) to Initial Licensure Programs in Texas (1998-2007)

All RN Programs Diploma & ADN Programs BSN Programs

Source: Texas Center for Nursing Workforce Studies (TCNWS).

*1998, 1999, 2000 data from the Texas Board of Nursing.

9

2. Offers of Admission From 1998 to 2007, offers of admission increased by 125 percent. In 2007, the application and admission data show that 7,765 qualified applicants (duplicated) were not admitted to initial licensure programs. Based on a 2003 study of qualified applicants, the THECB estimates that approximately 10 percent of qualified applicants submit more than one application during an academic year.

4,998 4,991

7,446

8,672

9,457 9,147

10,80210,593 10,766

11,270

3,227 3,099

4,6805,117

5,643 5,737

6,7336,496 6,649

7,169

1,771 1,892

2,766

3,5553,814

3,410

4,069 4,097 4,117 4,101

0

2,000

4,000

6,000

8,000

10,000

12,000

1998* 1999* 2000* 2001 2002 2003 2004 2005 2006 2007

Total Offers of Admission to Initial Licensure Programs in Texas (1998-2007)




10

Based on a survey conducted by the Texas Center for Nursing Workforce Studies, “lack of budgeted faculty positions” is the most frequently stated reason that nursing programs gave for not admitting additional qualified applicants. However, space restrictions also limit enrollment capacity.

Lack of Clinical Space22%

Limited Classroom Space21%

Lack of Budgeted Faculty Positions

28%

of Qualified Faculty Applicants

21%

Other8%

Stated Reasons Why Qualified Applicants Are Not Admitted to ADN and BSN Programs in Texas (2007)

43% Space Limits

49% Faculty Limits

Lack


11

3. First-year Entering Enrollments From 1998 to 2007, first-year entering enrollments increased by 133 percent. Enrollment in BSN programs increased at a faster rate than Diploma and ADN programs.

4,3234,087

6,110

6,967

7,891 8,012

9,043 8,992

9,56710,066

2,9112,653

3,8684,333

4,8845,181

5,812 5,6296,028

6,491

1,412 1,434

2,2422,634

3,007 2,8313,231 3,363 3,539 3,575

0

2,000

4,000

6,000

8,000

10,000

12,000

1998* 1999* 2000* 2001 2002 2003 2004 2005 2006 2007

Total First-Year Entering Enrollment in Initial Licensure Programs in Texas (1998-2007)




12

4. Total Enrollment From 1998 to 2007, enrollments in initial licensure programs increased by 52 percent. BSN enrollments increased at a faster rate than in Diploma and ADN programs.

11,701 11,455 11,58912,172

13,540

14,84515,318

16,35016,711

17,841

7,058 6,833 6,6177,170

8,1338,621 8,930

9,2889,794

10,548

4,643 4,6224,972 5,002

5,4076,224 6,388

7,062 6,9177,293

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

1998* 1999* 2000* 2001 2002 2003 2004 2005 2006 2007

Total Enrollment in Intial Licensure Programs in Texas (1998-2007)

All Initial RN Programs Diploma & ADN Programs BSN Programs



13

5. Graduation Rates

In 2007, the statewide graduation rate was 69 percent. Programs at health-related institutions had the highest rate (86 percent), followed by universities (72 percent) and community colleges (66 percent).

Graduation rates by individual program for 2007 are included as Appendix F.

Number of

Enrollees

Graduated

100 %*

Graduated

150 %**

Total

Graduates

Percent

Graduated^

By Region

High Plains 581 51 325 375 64.7%

Northwest 248 129 32 161 64.9%

Metroplex 1,701 901 344 1,245 73.2%

Upper East Texas 619 340 89 429 69.3%

Southeast Texas 447 196 95 291 65.1%

Gulf Coast 1,488 755 177 932 62.6%

Central Texas 790 487 86 573 72.5%

South Texas 1,365 802 221 1,023 74.9%

West Texas 311 165 36 201 64.6%

Upper Rio Grande 222 58 81 139 62.6%

Total 7,772 3,884 1,486 5,369 69.1%

By Type of Program

1-year (LVN-ADN) 899 425 137 562 63%

2-year ADN and BSN 6,873 3,459 1,349 4,808 70%

Total 7,772 3,884 1,486 5,370 69.1%

By Type of Institution Delivering Program

Community College 4,864 2,592 612 3,204 65.9%

University 2,327 989 679 1,668 71.7%

Health-related Institution 581 303 195 498 85.7%

Total 7,772 3,884 1,486 5,370 69.1%

Sources: Texas public and independent institutions with initial licensure programs, Coordinating Board.

The following institutions are not included in the rate calculations: Cisco Junior College, St. Phillips

College, University of Mary Hardin-Baylor, Houston Baptist University, Covenant School of Nursing, Baptist

Health System

*Graduated 100 % - represents the number of students who graduated "on-time" in programs that norm-

ally can be completed in one year (LVN-ADN programs) or two years (general ADN or BSN programs).

**Graduated 150 % - represents the number of students who graduated from a one-year program in 18

months or from a two-year program in 36 months.

^Methodology: Final percentages were based on 150 percent time to graduation. Two-year program co-

horts who were admitted in either spring, summer, or fall of 2004, were tracked for 36 months, graduating

no later than December 2006, May 2007, or August 2007, respectively. One-year program cohorts who

were admitted in either spring, summer, or fall of 2005, were tracked for 18 months, graduating no later

than June 2006, December 2006 or February 2007, respectively.

Statewide Graduation Rates for Initial Licensure Programs (2007)

14

6. Graduates

Since 2001, the number of initial licensure program graduates has increased by 55 percent.

A six-year trend analysis of the number of graduates by individual nursing programs is included as Appendix G. The data from that analysis show:

The graduating classes of most of these programs are relatively small. In 2007, 71 percent of initial licensure programs had fewer than 100 graduates.

Nursing programs have difficulty sustaining increases in graduates from year to year. Of the 78 programs reporting graduates for each year from 2001-2007, only 2 institutions (2.5 percent) reported increases in graduates for each of the six years. Another 10 institutions (13 percent) showed increases in five of the six years.

Thirteen institutions (17 percent) had a net increase of 50 graduates or more over the six-year period.

5,156 5,042

4,615 4,531 4,609

5,243

5,677

6,029

6,674

7,031

3,243 3,371

2,896 2,832 2,833

3,3683,632 3,760

4,1734,352

1,9131,671 1,719 1,699 1,776 1,875

2,0452,269

2,5012,679

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

1998* 1999* 2000* 2001 2002 2003 2004 2005 2006 2007

Graduates from Initial Licensure Programs in Texas (1998-2007)

All Initial RN Programs Diploma & ADN Programs BSN Programs



The Gulf Coast, Metroplex, and South Texas (excluding Bexar County) regions have the fewest initial licensure graduates per 100,000 population. Despite these discrepancies, the Gulf Coast and Metroplex have more practicing nurses per 100,000 population than other regions. (See also page 38.)

Initial Licensure Graduates per 100,000 Population by Region (2007)

Statewide Average: 30

72

45 20 58

29 34 30 43

32 24 Excluding Bexar

County: 26


When the number of initial licensure graduates within a region is compared to the total population of a region, the High Plains region has the highest ratio of graduates to 100,000 population, and the Metroplex region has the lowest ratio of graduates to 100,000 population.

Comparison of the Regional Population and Initial Licensure Graduates (2007)

Percent of Texas Percent of Texas Percent

Regions Initial Licensure Texas PopulationPopulation Difference

GraduatesHigh Plains 8.5% 833,764 3.6% 4.9%

Northwest 3.7% 567,635 2.4% 1.2%

Metroplex 17.8% 6,226,815 26.8% -8.9%

Upper East Texas 8.9% 1,069,458 4.6% 4.3%

Southeast Texas 4.8% 777,670 3.3% 1.4%

Gulf Coast 18.9% 5,436,942 23.4% -4.4%

Central Texas 11.3% 2,621,139 11.3% 0.1%

South Texas 20.1% 4,380,974 18.8% 1.3%

West Texas 2.7% 552,621 2.4% 0.3%

Upper Rio Grande 3.2% 792,899 3.4% -0.2%

Population 100% 23,259,917 100% ----------

15

16

7. Gender and Ethnicity Despite efforts to recruit men into nursing, the state‟s ADN and BSN graduates are predominantly women.

The ethnicity of ADN and BSN graduates closely mirrors the ethnicity of the state‟s associate and baccalaureate degree graduates from all degree programs. Both sets of graduation data show that Hispanics are significantly under-represented.

Male15%

Female85%

ADN and BSN Graduates by Gender (2007)

Source: Coordinating Board.

Ethnicity of ADN and BSN Degree Graduates With Comparative Data (2007)

Ethnic Group ADN/BSN Graduates*

Associate/Baccalaureate

Graduates (All Degrees)

Percent of Texas

Population

White 60% 59% 49%

African American 10% 9% 11%

Hispanic 19% 22% 36%

Asian/Other** 11% 10% 4%

Total 100% 100% 100%

* Includes initial licensure and associate degree-to-baccalaureate degree program data.

**"Other" includes Native American, International, and Unknown.

Sources: Graduates: Texas Public Institutions. Population: Texas State Demographer using a 0.5 migration

scenario.

17

8. Educational Pipeline

Based upon historical trends, THECB staff estimates that 89 percent of students offered admission to initial licensure programs will enroll and that 69 percent of these enrollees will complete the program.

A more detailed view of the pipeline based on historical trends by degree level is included as Appendix G.

Based upon a more ideal scenario where programs would have capacity to offer admission to 85 percent of those students who applied, 89 percent of those admitted were enrolled, and 85 percent of enrolled students graduated (based on the statewide target), the number of graduates would almost double.

19,035

11,270

10,066

6,946

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Applications

(Duplicated)

Offers of Admission

(Duplicated)

First-Year Entering

Students

Estimated

Graduates

Historical Educational Pipeline to Obtaining a Degree from an Initial Licensure Program in Texas (2007)

Sources: Texas Center for Nursing Workforce Studies and the Coordinating Board.

19,035

16,180

14,400

12,240

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Applications

(Duplicated)

Offers of Admission

(Duplicated)

First-Year Entering

Students

Estimated

Graduates

Optimal Educational Pipeline to Obtaining a Degree from an Initial Licensure Program in Texas (2007)

Source: Coordinating Board

18

9. Initial Licensure Graduates and the Projected Need for Nurses

Based upon a graduation trend analysis, the gap between the number of initial licensure graduates produced and the number needed will increase through 2020.

8,510 8,989 9,468 9,946 10,425 10,904 11,382 11,861 12,340 12,819 13,2979,717

12,065

14,59315,199

17,11717,777

19,38320,073

23,30224,085

24,870

0

5,000

10,000

15,000

20,000

25,000

30,000

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Graduation Projections versus U.S Health Resources and Services Administration Model Projections

Baseline Supply of Graduates* Total Supply of Graduates Needed**


*Numbers are based on a simple regression formula of actual graduation data reported from 2002 to 2007. Graduation numbers do not include

those from programs that have not yet produced graduates.

**U.S. Health Resources and Services Administration, Supply Model.

19

The number of practicing nurses is projected to rise with the population. Trends suggest that the percentage increase in practicing nurses will continue to outpace the percentage increase in graduates, suggesting that the state will face a more severe nursing shortage.

81,320

98,868

124,495

144,602

169,130

192,429

215,729

4,043 4,329 4,615 6,029 8,510 10,904 13,297

0

50,000

100,000

150,000

200,000

250,000

1990 1995* 2000 2005 2010* 2015* 2020*

Texas Initial Licensure Graduates and Nurses

Nurses Graduates

Sources: Graduates and Nurses: Coordinating Board, Texas Board of Nursing, and Texas Center for Nursing Workforce Studies.

*All projections based on a simple regression formula. Number of graduates for years 2010, 2015, 2020 does not include those for new

programs that have not yet produced graduates as of 2007.

17.0

18.7

20.9

22.5

24.3

26.2

28.0

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

1990 1995* 2000 2005 2010* 2015* 2020*

Texas Population

Population (Millions)

Source: Texas State Demographer.

*All projections based on a simple regression formula. Number of graduates for years 2010, 2015, 2020 does not include those for new programs that have not yet produced graduates as of 2007.

20

II. Graduate Education and Potential Faculty

The graduate education section is divided into three parts. Part A presents data on all graduate programs (master‟s and doctoral). Part B presents data on Master of Science in Nursing (MSN) programs, including: nursing administration, nursing educator, and advanced practice nursing programs. Part C presents data on doctoral programs, including Doctor of Philosophy (Ph.D.) in Nursing and Doctor of Nursing Practice (DNP) programs. Graduate education programs in Texas are offered in general academic universities, health-related institutions, and independent universities and include:

Master of Science in Nursing (MSN) degree programs: admits students with baccalaureate nursing degrees and awards a master‟s of science in nursing. There are three distinct types of MSN programs offered in Texas:

Nursing Administration programs: prepare graduates to assume a variety of leadership positions within the health care system.

Nursing Educator programs: prepare graduates to teach in a variety of nursing programs including vocational, associate, and baccalaureate programs.

Advanced Nursing Practice programs: prepare graduates to practice

in an expanded nursing role to provide primary care to individuals, families, or groups in a variety of health care settings. The advanced practice nurse (APN) acts independently and/or in collaboration with a physician. APN programs prepare registered nurses in one of four roles:

Nurse practitioner: prepares graduates to function in an advanced health care provider role addressing the full range of patient‟s health problems and needs within an area of specialization. Specialization practice areas include acute care (adult and pediatric), adult, family, gerontological, neonatal, pediatric, psychiatric/mental health, and women‟s health.

Clinical nurse specialist: prepares graduates to provide care on a specific patient population within a specialty area, including adult health/medical-surgical, community health, critical care, gerontology, pediatrics, and psychiatric/mental health. Patient care includes clinical practice, teaching, research, consulting, and management.

Nurse midwifery: prepares graduates to independently manage women‟s health care services relating to pregnancy, childbirth, and the postpartum period. They may also provide normal newborn care and primary health care for women. Currently there are no nurse midwifery programs offered in Texas.

21

Nurse anesthetist: prepares graduates to manage the anesthesia needs of patients of all ages, including pre-anesthetic assessment and evaluation, anesthesia planning, anesthesia administration and monitoring, and post-anesthesia care.

Doctoral Programs: Two types of doctoral programs are offered in Texas:

Doctor of Philosophy (Ph.D.) programs: research-focused doctoral degree programs that admit RNs with master‟s degrees in nursing. Prepare graduates to pursue intellectual inquiry and conduct independent research for the purpose of advancing knowledge. Prepare nursing faculty for baccalaureate, master‟s and doctoral education programs.

Doctor of Nursing Practice (DNP) programs: practice-focused doctoral

degree programs that prepare graduates for the highest level of nursing practice beyond the initial preparation in the discipline.

Additional MSN and post-master‟s certificate programs include:

MSN in Public Health Nursing: prepares graduates for clinical practice in health promotion and disease prevention in high-risk populations at the local, state, and national levels.

MSN for non-nursing college graduates: these programs are often called 2nd

degree MSN programs and admit students with baccalaureate degrees in other disciplines. Graduates are prepared for entry into the profession and awarded a master‟s degree in nursing.

Post-master‟s nurse practitioner certificate programs: prepare graduates for clinical practice in a specialty area.

Post-master‟s certificate option in nursing education: prepares future nursing

faculty with courses in curricular and instructional design.

Source: American Association of Colleges of Nursing.

The following table shows the distribution of these types of graduate programs:

Graduate Programs in Texas (2007)

Type of Program Number of Programs Percentage of 2007 Graduates *

MSN – Nursing Administration 19 15%

MSN – Nursing Educator 18 9%

MSN – Advanced Practice Nursing 30 71%

Ph.D. 7 5%

Doctor of Nursing Practice 7 0%

Total Programs 81 100% *”Percentage of 2007 Graduates” represents the percentage of graduate students who graduated from master‟s and doctoral programs in 2007. The 81 programs reported a total of 977 graduates.

22

A. Student Data for All Graduate Programs From 2003 to 2007, first-year enrollment, total enrollment and graduates increased for master‟s and doctoral programs in nursing. Since 2003, the total enrollment of graduate nursing students has increased by 56 percent, peaking in 2007 at 3,837. Despite the growth of these programs, the number of graduates prepared to teach in initial licensure programs is not sufficient to alleviate current and future nursing faculty shortages. 1. First-year Entering Enrollments

Since 2003, the number of first-year entering doctoral nursing students increased by 10 percent. The number of master‟s students increased by 32 percent. In 2007, master‟s level students represented 93 percent of all first-year entering enrollees in graduate nursing education.

910

1,065

1,260

1,018

1,205

77 84 68 64 85

0

200

400

600

800

1000

1200

1400

2003 2004 2005 2006 2007

First-Year Entering Enrollment in Master's and Doctoral Nursing Programs in Texas

Master's Doctoral

Sources: Texas public and independent graduate nursing programs and Coordinating Board.

Appendix J contains a list of schools that submitted incomplete or no data.

23

2. Total Enrollment

From 2003 to 2007, the number of graduate nursing students increased by 56 percent.

2,282

2,756

3,216 3,248

3,438

175

341 340 368 399

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

2003 2004 2005 2006 2007

Total Enrollment in Master's and Doctoral Nursing Programs in Texas (2003-2007)

Master's Doctoral



24

3. Graduates

From 2003 to 2007, the number of master‟s level graduates increased by 96 percent. Doctoral student graduates have increased by 76 percent during the same period.

475

619

684

769

933

25 23 24 2344

0

100

200

300

400

500

600

700

800

900

1000

2003 2004 2005 2006 2007

Graduates of Master's and Doctoral Nursing Programs in Texas

Master's Doctoral



25

B. Master of Science in Nursing Programs

1. Schools with Master of Science in Nursing Educator Programs

Angelo State University Lamar University Lubbock Christian University Midwestern State University *Patty Hanks-Shelton School of Nursing Prairie View A&M University Texas A&M University - Corpus Christi Texas A&M University - Texarkana Texas Christian University

Texas Tech University Health Sciences Center University of Mary-Hardin Baylor University of Texas at Brownsville University of Texas at El Paso University of Texas at Pan American University of Texas at Tyler University of Texas Medical Branch at Galveston The University of Texas at Austin West Texas A&M University

*A consortium of Abilene Christian, Hardin-Simmons, and McMurry Universities.

Post Master‟s Certificate Nursing Educator Programs

Angelo State University Baylor University Texas Woman‟s University, Dallas campus Texas Woman‟s University, Denton campus Texas Woman‟s University, Houston campus

University of Texas at Arlington University of Texas at El Paso University of Texas at Tyler University of Texas Health Science Center at San Antonio


26

2. First-year Entering Enrollments

In 2007, only 11 percent of all master‟s students were enrolled in nursing educator programs that specifically prepare students as future nursing faculty.

910

1,065

1,260

1,018

1,205

763

859

967

767

912

96155

195164

163

5151

98 87 130

0

200

400

600

800

1,000

1,200

1,400

2003 2004 2005 2006 2007

First-Year Enrollments in MSN Programs in Texas

Total MSNs APNs Nurse Administrator Nurse Educator



27

3. Total Enrollment

Since 2003, total enrollments of master‟s level programs have increased (51 percent), with the most significant increase occurring in MSN-nursing educator programs (141 percent). Despite the enrollment increases in MSN-nursing educator programs, they represent only 11 percent of all master‟s level enrollments.

2,282

2,756

3,216 3,248

3,438

1,885

2,195

2,503 2,498 2,546

234392 434 471 499

163 169 279 279393

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

2003 2004 2005 2006 2007

Total Enrollments in MSN Programs in Texas




28

4. Graduates

Graduates from MSN programs have increased significantly with nursing educator programs having the largest increase (493 percent) of all master‟s programs. MSN-nursing educator graduates represent less than 10 percent of all master‟s level graduates.

475

619

684

769

933

409

487

564

636

696

51

9879 78 148

15 34 41

5589

0

100

200

300

400

500

600

700

800

900

1,000

2003 2004 2005 2006 2007

Graduates from MSN Programs in Texas




29

C. Doctoral Programs

1. Schools with Ph.D. Programs

Institution Year Established Texas Woman‟s University* 1971 University of Texas at Austin 1974 University of Texas at Arlington 2003 University of Texas at Tyler 2008 University of Texas Health Science Center at San Antonio 1991 University of Texas Health Science Center at Houston 1996 University of Texas Medical Branch at Galveston 1997 *TWU program is offered at Denton and Houston campuses and also at Texas Tech University Health Sciences Center.

Source: Coordinating Board

30

2. Schools Offering Doctor of Nursing Practice Programs


Institution Year Established Baylor University 2008 2008 Texas Christian University 2007 Texas Tech University Health Sciences Center 2007 Texas Wesleyan University 2008 Texas Woman‟s University (Dallas campus) 2007 University of Texas at Arlington 2008 University of Texas Health Science Center at Houston 2006

31

3. Applications

From 2003 to 2008, applications to Ph.D. programs increased by 136 percent. From 2007 to 2008

when DNP programs started, there has been a 286 percent increase in DNP applications.

55

98117 124 133 130

49

189

0

50

100

150

200

250

300

350

2003 2004 2005 2006 2007 2008

Applications to Doctoral Programs in Texas

Ph.D. DNP


182

319

32

4. First-year Entering Enrollments

In 2008, first-year entering enrollment in DNP programs exceeded first-year entering enrollment in Ph.D. programs.

7784

68 64 69

54

16

88

0

20

40

60

80

100

120

140

160

2003 2004 2005 2006 2007 2008

First-Year Entering Enrollments in Doctoral Programs in Texas

Ph.D. DNP


85

142

33

5. Total Enrollment

In 2008, total Ph.D. enrollment increased from 2004 by 5 percent. From 2007 to 2008, DNP total enrollment increased 625 percent.

175

341 340368 383

358

16

116

0

50

100

150

200

250

300

350

400

450

500

2003 2004 2005 2006 2007 2008

Total Enrollments in Doctoral Programs in Texas

Ph.D. DNP


399

474

34

6. Graduates

From 2003 to 2008, graduates in Ph.D. programs increased 128 percent.

2523

2423

44

57

0

10

20

30

40

50

60

2003 2004 2005 2006 2007 2008

Graduates of Ph.D. Programs in Texas*


*These graduates only represent Ph.D. graduates since the Doctor of Nursing Practice will not have a cohort of graduates until 2009.

35

III. Initial Licensure Nursing Faculty

The vast majority of initial licensure faculty have master‟s degrees in nursing (75 percent) or in another field (4 percent). Only 10 percent of all master‟s and doctorally-prepared faculty have degrees in disciplines other than nursing.

Masters in Nursing75%

Masters in Other Field4%

Doctorate in Nursing11%

Doctorate in Other Field6%

Faculty Waiver*3%

Academic Degrees of Faculty (2007)

Source: Texas Center for Nursing Workforce Studies.

*Faculty waiver -- a waiver granted by a dean of a professional nursing educational program to an individual who has a baccalaureate degree in

nursing and is currently licensed in Texas, to be employed as a faculty member which is valied for up to one year.

36

The average age of all nursing faculty is 53 years. Approximately 94 percent of full-time ADN nursing faculty and 67 percent of full-time BSN nursing faculty earn on average less than $66,000 per year (adjusted to a 12-month salary).

Rank

Average

Age

Number of

Faculty 9-month Salaries

12-month Salaries

(Adjusted)*

Community Colleges

Professor 55 36 $52,988 $70,651

Associate Professor 54 61 $49,410 $65,880

Assistant Professor 54 64 $46,552 $62,069

Instructor 50 196 $43,480 $57,973

Other Faculty 49 20 $42,186 $56,248

No Ranking System 51 229 $46,610 $62,147

Average of All Ranks 53 606 $46,061 $61,415

Universities

Professor 59 35 $84,062 $112,083

Associate Professor 56 68 $64,732 $86,309

Assistant Professor 53 72 $59,046 $78,728

Instructor 35 1 $54,000 $72,000

Other Faculty 51 361 $48,772 $65,029

Average of All Ranks 53 537 $52,898 $70,531

Rank

Average

Age

Number of

Faculty 12-month Salaries**

Health-Related Institutions

Professor 61 29 $118,567

Associate Professor 56 40 $94,200

Assistant Professor 49 37 $75,860

Other Faculty 52 41 $71,900

Instructor 43 20 $65,757

Average of All Ranks 53 167 $84,651

Source : Institutional data reported to the Texas Higher Education Coordinating Board.

*9-month salaries are adjusted to 12-month salaries for purposes of comparing them to practice salaries.

**Some nursing faculty have 9-month salaries.

2007 Average Ages and Median Salaries for Full-time Nursing Faculty

at Texas Public Institutions

37

Advanced practice nurses and nurses in supervisory or managerial positions earn on average between $66,387 (25th percentile) and $88,602 (75th percentile) in practice. Nursing schools located in large metropolitan areas such as Houston and Dallas would most likely have a significantly more difficult time recruiting nursing faculty at the lower range of this pay scale.

More information on salaries by location is included as Appendix K.

The table on page 36 shows that there are three different types of institutions employing nursing faculty, each with a different faculty salary scale. The table on this page shows that the average salary for positions which most likely would require a graduate degree is $80,055 (the average of $63,993 and $96,117 above) or $60,041, if adjusted to a nine-month salary.

To bring existing faculty salaries into parity with practice salaries, the THECB estimates that it would cost approximately $24.3 million for the 2010-11 biennium.

Range of Average Salaries for Advanced Practice

and Supervisory Nurse Positions in Texas (2008)

Lowest Salary Highest Salary

Position Location

25th

Percentile Location

75th

Percentile

Nurse Practitioner Brownsville $64,387 Houston $89,909

Clinical Nurse Specialist Brownsville $63,304 Houston $88,602

Head Nurse (general) Brownsville $66,363 Houston $98,341

Head Nurse (Emergency Room) Brownsville $64,534 Houston $101,124

Head Nurse (Intensive Care) Brownsville $72,012 Houston $107,914

Head Nurse (Operating Room) Brownsville $67,398 Houston $110,157

Head Nurse (Critical Care) Brownsville $69,007 Houston $106,620

Nurse Education Coordinator Abilene $53,933 Houston $80,225

Transplant Nurse Coordinator Brownsville $57,389 Houston $80,869

Head Nurse (Psychiatric) Brownsville $61,594 Houston $97,410

$63,992 $96,117

Source: Salary.com

Average Salary - All Positions

Salary.com is used by the Texas Center for Nursing Workforce Studies and other states‟ nursing centers to compare state and

national nursing salaries. The site has 7,000 corporate subscribers and data resources representing 10 million employees. The

data offered through the site are compiled from employer–reported market surveys and proxy data that have been verified by

certified compensation professionals.

38

IV. Practitioner and Practice Trends

The Upper Rio Grande and South Texas regions (excluding Bexar County) have the fewest nurses per 100,000 population.

Sources: Texas Board of Nursing and Coordinating Board.

Texas Nurses per 100,000 Population by Texas Region (2007)

847

696 666 813

671

699

2

622

623

Excluding Bexar

County: 448

655 489

Statewide Average (2007): 668 National Average (2004): 848

39

Texas is eighth in the number of nurses per 100,000 population among the 10 most populous states.

640

819

665

811837

865904

1,001 1,016

668

823

0

200

400

600

800

1,000

1,200

Ratio of Nurses to 100,000 Population in the10 Most Populous States (2007)

Sources: U.S. Department of Labor, Bureau of Labor Statistics, and the U.S. Census Bureau. Texas Population: Texas State Demographer using

a 0.5 migration scenario.

*Average is for the 10 most populous states.

40

Eighty-six percent of Texas nurses have a Diploma, an ADN or BSN in nursing. Approximately 8 percent have a master‟s or doctoral degree in nursing.

Fifty-eight percent of all Texas nurses are between the ages of 40 and 59.

Diploma10%

Associate Degree in Nursing40%

Baccalaureate in Nursing36%

Baccalaureate in Other Fields4%

Masters in Nursing7%

Masters in Other Fields3%

Doctorate in Nursing or in Other Field

<1%

Texas Nurses by Highest Degree Earned (2007)

Sources: Texas Board of Nursing and Texas Department of State Health Services.

20-298%

30-3924%

40-4928%

50-5930%

60-6910%

70-991%

Texas Nurses by Age (2007)

Sources: Texas Board of Nursing and Texas Department of State Health Services.

41

Fifty-nine percent of Texas nurses are staff nurses, and 16 percent work in administrative or supervisory positions. Only 2 percent identify themselves as faculty/educators.

Sixty-four percent of Texas nurses work in or for a hospital.

Administrative / Supervising

16%

Researcher / Consultant2%

Faculty / Educator2%

Staff Nurse / General Duty59%

Advanced Practice Nurses5%

Other / Unknown9%

School / Office Nurse6%

Texas Nurses by Type of Practice (2007)

Source: Texas Board of Nursing and Texas Department of State Health Services.

Inpatient or Outpatient Hospital Care

64%

School Health4%

Physician / Private Practice

4%

Freestanding Clinic2%

Home Health Agency6%

Nursing Home/Extended Care Facility

3%

Other*16%

Texas Nurses by Practice Location (2007)

Source: Texas Board of Nursing and Texas Department of State Health Services.

*"Other" includes the employment fields of School of Nursing, Community/Public Health, Self- Employed/Private Practice, Rural Health Clinic, Military

Installation, Temporary Agency/Nursing Pool, Business/Industry, and Unknown. All of these employment fields, counted individually, represent less

than 3 percent of the total.

42

V. Strategies for Increasing Capacity and Student Success in Nursing

Education

A. Initial Licensure Education Strategies to increase the number of initial licensure graduates address the two major challenges of increasing enrollment capacity and improving student graduation rates. Meeting Statewide Targets for the Number of Graduates through Regional and Local Collaboration

In recent years, the THECB has promoted educational partnerships and the sharing of scarce resources through regional coordination or collaboration. Many of the grant projects funded through the Nursing, Allied Health and Other Health-Related Education Grant Program have supported a limited range of educational activities that require collaboration among nursing programs and between nursing programs and their hospital affiliates. A list of current grant projects is included as Appendix L.

The THECB is now recommending that regional and local coordination play a greater role in increasing the number of graduates at the institutional level. In A New Curriculum Model for Initial RN Licensure Programs, the THECB proposes implementing a common curriculum that would be modified to incorporate best practices at the regional level. The proposed plan promises to offer efficiencies in nursing education without losing the benefits of adapting the curriculum to regional differences. The curriculum may help institutions increase the number of graduates by institutionalizing best practices in nursing education as well as better leveraging institutional and faculty resources.

Regional and local coordination could also help nursing programs focus on specific graduation targets. This strategy would require that the THECB calculate each region‟s and each institution‟s share of the statewide projections for new graduates, and include the subsequent targets in each institution‟s data profile within the Higher Education Accountability System. Nursing programs could use those performance targets for developing a “business plan” with their institutions‟ administrations, build community partnerships, and solicit support from local and regional health care providers.

Reward Programs that Meet Graduation Rate Targets or Show Improvement toward those Targets

Nursing students face a number of challenges in completing their degrees. Unlike many students who have difficulty in their first year at a community college or university, nursing students have previously demonstrated academic success in required prerequisites (ADN students) or prerequisites and core curriculum courses (BSN students) before being admitted to an initial licensure program. Despite that early success, research shows that various challenges exist for these students and for nursing faculty to ensure that these students are successful in completing their degree programs. In its 2006 report, Strategies to Increase the Number of Graduates from Initial RN Licensure Programs, the THECB identified many of these challenges:

In 2005, the average entering nursing student was considerably older (26 years) than her or his counterparts in comparable associate and baccalaureate degree programs (20 years). The age difference suggests that these students have more family commitments, financial demands, and work-related issues than the average student.

43

Survey responses from nursing students who were in their last semester of an initial licensure program indicated that 38 percent of ADN students and 21 percent of BSN students worked more than 20 hours a week during one or more semesters while they were in the program.

Only 69 percent of students (from a 2003 enrollment cohort), who previously had shown academic success in higher education, graduated or were persisting in the initial licensure program.

Students who received financial aid for two or more years were more likely to complete or persist in the program (83 percent).

Nursing programs did not have a systematic way of identifying at-risk students and had little evidence to show which of the various academic services provided to these students were most effective.

The findings led the THECB to a number of recommendations directed specifically at nursing programs, including setting a target for graduation rates in initial licensure programs, developing work-study programs between nursing programs and the health care industry, increasing financial aid for nursing students, and creating a staff position dedicated to providing assistance to students during times of financial and personal crisis. In response to the 2006 study, the 80th Texas Legislature directed the THECB to calculate annual graduation rates for the state‟s initial licensure programs and to establish a program to recognize schools that had an 85 percent graduation rate or higher. The THECB established rules for the program, the Nursing Education Performance Initiative, and calculated the first year of graduation rates in 2007. Those results are shown on page 13.

For schools to be recognized through the Initiative, a school must have an 85 percent graduation rate or higher and an 85 percent pass rate or higher on the national licensing exam. It must also demonstrate that its high graduation rate is a result of specific strategies to retain at-risk students in the nursing program and provide a plan for disseminating information about those strategies.

Despite the requirement that successful schools show how those rates have been obtained, some schools may have a distinct advantage in being recognized for their high graduation rates. Schools with the highest graduation rates in 2007 (Appendix F) often have the most competitive admission criteria, and thereby, the best-prepared nursing students. For other nursing programs to achieve similar graduation rates, they will need additional support to improve or expand their student retention efforts. The THECB recommends that the Texas Legislature provide funds so that both nursing programs that meet the qualification for recognition and nursing programs that have shown significant progress toward higher graduation rates receive incentive funding for those accomplishments. To qualify for funding without reaching the 85 percent targets, a program would need to have a graduation rate above 50 percent and an increased graduation rate from one year to the next of more than 10 percent.

THECB estimates that if 26 nursing programs were eligible for incentive funding each year and incentives were set at $15,000 per eligible program, the state would need to appropriate $780,000 to the Initiative for the 2010-11 biennium.

44

B. Graduate Education and Potential Nursing Faculty

The state will need new nursing faculty to increase enrollment capacity and to improve student graduation rates in initial licensure program. New nursing faculty could come from practice or from graduate degree programs that prepared nurses specifically for faculty positions.

Graduate Nurses’ Education Loan Repayment Program

To enhance recruitment and retention of qualified faculty during a time of faculty shortages in nursing, the Texas Legislature should fund the Graduate Nurses‟ Education Loan Repayment program through General Revenue. The Graduate Nurses‟ Education Loan Repayment Program was established by Texas statute in 1989 to encourage qualified graduate professional nurses to serve as faculty in nursing education programs. The program was not funded. If it were funded, the program would repay eligible student loans of nursing faculty who meet stipulated requirements, including serving on the nursing faculty of an eligible nursing program for at least one year preceding loan repayment.

The estimated cost to fund the loan repayment program would be $1.5 million and would support 105 professionals for the next biennium. The cost is based on repayment of half of the number of students graduating from MSN in Nursing Education programs and Ph.D. in nursing programs receiving the maximum repayment per year ($7,000) for the 2010-2011 biennium.

C. Initial Licensure Nursing Faculty Supporting Growth in Initial Licensure Nursing Faculty

The challenges facing nursing education in Texas can be called a “perfect storm.” The projections for new nurses show that the state‟s initial licensure programs will need to double the number of nurses from 2007 to 2012 and then almost double those numbers again by 2020. Furthermore, the Texas Center for Nursing Workforce Studies estimates that 66 percent of all faculty are eligible to retire in the next 12 years. Given the current job market for all levels of nursing care, nursing programs will have a significant challenge replacing retiring faculty and hiring for new positions. In 2005, the Texas Legislature created the Professional Nursing Shortage Reduction Program as a statewide pool of funding to support nursing faculty. The program currently distributes approximately $14 million on a pro rata basis to nursing schools that show an increase in their total number of nursing graduates from one year to the next. Nursing schools that are eligible for these funds can use the money to create additional nurse faculty positions, provide temporary salary supplements to faculty, and engage qualified preceptors (practicing nurses who agree to train and mentor students in the work setting) to expand faculty capacity. In fiscal year 2008, Program funds created 75 new faculty positions and paid 555 temporary salary supplements to existing faculty. To ensure continued expansion of nursing programs, the THECB has requested an additional $10 million for the 2010-11 biennium and an amendment to the appropriation rider which prescribes the use of award funds (Rider 40, III-54). The proposed amendment would allow schools to use the funds to pay stipends to graduate nursing students who are enrolled in nurse educator certificate and degree programs and Ph.D. nursing programs. The stipends would help these graduate students complete their degrees and begin working as full-time faculty in a shorter period of time.

45

VI. Summary of Key Findings and Recommendations

Key Findings

Initial Licensure Education

Since 1998, initial licensure programs have increased significantly in applications (124 percent), first-year enrollments (133 percent), and total enrollments (52 percent). Since 2001, initial licensure graduates have increased by 55 percent.

To keep up with the demand for new registered nurses, the state‟s nursing programs will need to double the number of initial licensure graduates (approximately 14,000) by 2012 and nearly double that number again (approximately 24,000) by 2020.

From 2001 to 2007, only two of the state‟s initial licensure programs increased the number of graduates in each of those six years, and only 13 programs had net increases of 50 graduates or more during this six-year period. Due to these variations across programs, institutions may benefit from having established graduation targets.

In 2007, the statewide graduation rate for one-year and two-year initial licensure programs was 69 percent. The statewide rate varied widely by institution from 22 percent to 98 percent. Programs at health-related institutions had the highest overall graduation rates (86 percent), followed by those at universities (72 percent) and community colleges (66 percent).

Graduate Education and Potential Nursing Faculty

Since 2003, the total enrollment of graduate nursing students has increased by 56 percent, peaking in 2007 at 3,837.

From 2003-2007, the number of graduates from Master of Science in Nursing (MSN) programs increased by 96 percent. Doctoral graduates increased by 76 percent during the same time period.

Despite the increased enrollment in graduate nursing programs, the shortage of nursing faculty remains a significant concern for the state.

Master‟s Programs

Since 2003, there has been a steady increase in the total enrollment of master‟s students (51 percent) with the most significant increase occurring with nursing educator program enrollment (141 percent).

Graduates from master‟s nursing programs have increased significantly with nursing educator having the highest increase (493 percent) of all master‟s nursing programs. However, for 2007, less than 10 percent of all master‟s level graduates were from nursing educator programs.

46

There are currently 18 MSN degree programs that prepare nursing educators. Post-master‟s nursing educator certificate program options are offered at nine institutions. These certificate programs offer courses in curricular and instructional design for master‟s-prepared nurses whose graduate preparation is in another specialization area, such as advanced practice nursing.

Doctoral Programs

In 2008, the first-year entering enrollment in Doctor of Philosophy in Nursing (Ph.D.) programs was the lowest in the last six years. This decrease may be attributed to the Doctor of Nursing Practice (DNP), the new professional doctoral program for advanced practice nurses. Since 2006, seven DNP programs have been established in Texas, in addition to the seven Ph.D. programs. From 2007 to 2008, DNP total student enrollment increased by 625 percent.

Initial Licensure Faculty

The average age of all nursing faculty is 53 years. Approximately 66 percent of nursing faculty are eligible to retire within the next 12 years.

With nursing faculty salaries well below those for master‟s-prepared nurses in practice, recruiting new faculty from practice will be difficult.

To expand on the success of the existing Professional Nursing Shortage Reduction Program, THECB requested an additional $10 million for the 2010-11 biennium. The request also proposed an amendment to the appropriation rider to allow funds to be used for stipends for future nurse educators.

Practitioner and Practice Trends

Only a small portion of nurses are qualified to be faculty in initial licensure programs. Less than 12 percent of all Texas nurses have graduate degrees.

The state has fewer nurses per 100,000 population than eight of the 10 most populous states and the 2004 national average.

The Upper Rio Grande and South Texas regions (excluding Bexar county) have the fewest nurses per 100,000 population.

Recommendations The THECB recommends the following strategies or actions to increase the number of nursing graduates from Texas institutions:

The THECB should establish institution-specific graduation targets for initial licensure programs in the state‟s Higher Education Accountability Systems for community colleges, universities, and health-related institutions.

47

To improve graduation rates, the Texas Legislature could provide incentive funding for those nursing programs that achieve an 85 percent or higher graduation rate or that have made significant progress toward the 85 percent graduation rate.

The Legislature could provide funding for the existing Graduate Nurses‟ Loan Repayment Program. The funds would repay the student loans of graduates from MSN in nursing educator programs and Ph.D. in nursing programs at a cost of $7,000 per year for each student.

The Texas Legislature should increase funding for the Professional Nursing Shortage Reduction Program by $10 million and amend the Program‟s appropriation rider to allow eligible institutions to use the funds to pay stipends to graduate students who enroll in nurse educator degree or certificate programs.

48

Data Sources

American Association of Colleges of Nursing

Texas Board of Nursing

Texas Center for Nursing Workforce Studies

Texas Department of State Health Services


Texas public and private institutions of higher education offering nursing education

Texas State Demographer

Texas Team Addressing Nursing Education Capacity

U.S. Census Bureau

U.S. Department of Labor. Bureau of Labor Statistics

U.S. Health Resources and Services Administration

Appendix A

Status of Key Recommendation from Previous THECB Reports on Initial Licensure

Nursing Programs and Nursing Faculty

From the THECB report, Increasing Capacity and Efficiency in Programs Leading to Initial RN Licensure

in Texas, 2004.

RN Education Programs

THECB, educational institutions, and the nursing community should set statewide goals for increasing the number of initial RN licensure graduates and identify funding required to produce these results.

Status report: Senate Bill 132, 79th Texas Legislature directed the Texas Department of Health‟s Texas Center for Nursing Workforce Studies (TCNWS), to develop a model for making projections of the need for nurses in the state. THECB was directed to identify the costs of increasing enrollments to meet those projections. The projections and cost estimates were included in recommendations in reports from the TCNWS and the THECB in 2006.

THECB, educational institutions, and the nursing community should study retention rates of nursing programs and establish a forum for promoting best practices.

Status: The THECB first calculated retention and graduation rates in 2005 and reported the results of those calculations in 2006. Senate Bill 138, 80th Texas Legislature directed THECB to develop a program for calculating annual graduation rates and rewarding programs that show best practices in reaching an 85 percent graduation rate. Graduations rates for 2007 are shown on page 13 of this report.

The Legislature should increase financial aid funding for the Professional Nursing Aid Program from $526,288

to $3.5 million for the biennium (a reallocation of $1.5 million in existing funds and $1,473,712 in new funds.) Cost: $ 1,473,712.

Status: Strategy D.1.9 of the THECB‟s bill pattern is currently funded at $1,837,130 for the 2008-09 biennium.

The Legislature should fund and educational institutions should establish a statewide or regional application and admissions center(s) for initial RN licensure programs. Cost: $250,000 for initial start-up in first two

years.

Status: Texas Tech University Health Sciences Center is currently piloting a regional application and admissions portal, involving 10 schools in West Texas, through a THECB grant. Initial results from the pilot will be available in October 2009.

THECB and educational institutions should continue to study articulation agreements between community

colleges, universities, and health-related institutions to determine and promote best practices.

Status: THECB has proposed a new curriculum model in its 2008 report, “A New Curriculum Model for Initial Licensure Programs.” The model would provide seamless transfer of students between programs and between levels of nursing instruction.

The Legislature should continue to support research in nursing education through the Nursing, Allied Health,

and Other Health-related Education Grant Program (NAHGP), a program funded from proceeds of the State‟s

Tobacco Lawsuit Settlement.

Status: The NAHGP funded 13 grants during the 2008-09 biennium. The grants focus primarily on work-based curriculum models, new efforts to prepare practice nurses for educator roles, partnerships with hospitals, course and curriculum redesign, and the regionalization of common academic and auxiliary activities. The NAHGP also supports a statewide nursing conference on partnerships in April 2009.

THECB, educational institutions, and others in the nursing community should promote innovation in nursing

education through the “regionalization” of common administrative and instructional functions, interdisciplinary instruction, pooled or shared faculty, and new clinical instruction models to maximize use of existing resources

and faculty.

Status: The NAHGP competitions continue to encourage collaborations among nursing programs and between nursing programs and the health care industry. Regionalization is also a key component in the THECB‟s 2008 report, “A New Curriculum Model for Initial Licensure Programs” and the Texas Team‟s “A Strategic Plan for the State of Texas To Meet Nursing Workforce Needs of 2012.”

Educational institutions and others in the nursing community should study K-12 curricula and make

recommendations to better prepare college-bound students for health care careers.

Status: In January 2008, the THECB approved college readiness standards for science and math.

The Legislature should provide special item funding to increase enrollments and retention in nursing programs

in South Texas (especially in areas outside Bexar County), where practice to population ratios are the worst in the state. Cost: $2.5 million for the biennium.

Status: Results on page 38 of this report show that South Texas region (excluding Bexar County) and El Paso region continue to have the lowest nurse to population ratios in the state.

RN Education Faculty

The Legislature, THECB, and educational institutions should establish incentives such as a loan repayment program for graduate students, particularly those from underrepresented groups, who are interested in

careers in nursing education. Cost: $ 1.4 million for the biennium.

Status: Currently there is no funding for the Graduate Nurses‟ Education Loan Repayment Program, a separate loan repayment program established (Texas Education Code Sections 61.651-61.658) to support graduate nursing students.

Educational institutions should make filling vacant nursing faculty positions and creating new faculty positions

at competitive salaries top priorities in budgeting decisions.

Status: From 2004 to 2007, TCNWS data show that faculty positions have increased by 13.4 percent whereas total initial licensure enrollments have increased by 16.4 percent.

The Legislature and educational institutions should increase ADN faculty salaries, and, in some cases,

instructor salaries at universities, to be more competitive with nurse practice salaries. Cost: $11 million for

the biennium.

Status: Community colleges continue to report the widest gap in pay for nursing faculty as compared to pay for practice nurses. THECB data show that the average salary (adjusted to 12-months) for faculty is $61,415, whereas the average master‟s prepared nurse in Texas can earn between $66,387 (25th percentile) and $88,602 (75th percentile).

Educational institutions and employers should reward nurses (e.g., academic credit or a stipend) who serve as

preceptors for nursing education programs.

Status: Senate Bill 132, 79th Texas Legislature created a THECB program to provide tuition waivers to preceptors or the children of preceptors. During fiscal years 2008, 129 students received waivers, totaling $734,666.

Educational institutions and employers should encourage joint appointments for practicing nurses to teach in

nursing programs.

Status: The THECB does not collect data on joint appointments; however, collaborations of this kind have been promoted in recent NAHGP grants competitions. In a recent Texas Board of Nursing survey, four programs reported sharing faculty between other nursing programs and 22 programs reported faculty positions funded by clinical/community affiliates.

From the THECB report, Strategies to Increase the Number of Graduates from Initial RN Licensure

programs, 2006.

Faculty Strategies

The Legislature and educational institutions should increase salaries of new and existing nursing faculty who teach in initial licensure programs. Increases should be implemented incrementally over two biennia with the

goal that by 2010 salaries for full-time faculty would be competitive with those of specific full-time positions in nurse practice.

Status: The 80th Texas Legislature increased funding to the Profession Nursing Shortage Reduction Program to $14.7 million. Program funds are used to support new and existing faculty positions and the use of preceptors.

The Legislature and educational institutions should provide stipends to full-time graduate nursing students

who commit to working as full-time faculty once they have completed their degree programs.

Status: The Legislature has not taken specific action on this recommendation; however, a proposed amendment to the appropriation rider for the Professional Nursing Shortage Reduction Program would allow eligible institutions to use funds to pay stipends to certain graduate students who are preparing to become nurse educators.

The Legislature should agree to provide schools additional per capita funding (through the Professional

Nursing Shortage education Program) for new graduates from the MSN Nurse Educator Track.

Status: THECB recommends revising the appropriation rider for the Professional Nursing Shortage Reduction Program to allow schools receiving these funds to pay stipends to graduate students who are enrolled in nurse educator degree programs.

Student Strategies

The Legislature should increase financial aid for students enrolled in initial licensure programs.

Status: In its 2010-11 Legislative Appropriations Request, the THECB requested approximately $634 million for additional financial aid to students and for college readiness and developmental education initiatives.

Educational institutions and employers should develop cooperative or “work-study” programs between nursing

programs and the healthcare industry.

Status: The THECB promoted work-study opportunities in its recent NAHGP competition. Eleven of 13 grants awarded involved nursing school-hospital educational partnerships.

THECB, educational institutions, and others in the nursing community should establish a statewide task force to study ways in which the healthcare industry can better partner with nursing programs to increase the

number of initial licensure graduates and improve completion rates.

Status: In 2007, The THECB established the Advisory Committee on RN Nursing Education (ACORN), which includes representation from the healthcare industry.

Program Administration Strategies

THECB, educational institutions and others in the nursing community should standardize data sets used by initial licensure programs for (1) student admissions, (2) student evaluation, and (3) students who drop out of

programs. Compile and analyze that data through a central repository.

Status: THECB is studying admission, evaluation, and drop-out data through a series of NAHGP and other research conducted by its Advisory Committee on RN Nursing Education.

THECB and educational institutions should implement a standard methodology for calculating completion and

persistence rates.

Status: Senate Bill 138, 80th Texas Legislature directed the THECB to establish a program for calculating graduation rates of initial licensure programs and recognizing schools that had an 85 percent graduation rate or higher. THECB enacted rules for the program in October 2007 and calculated rates for schools beginning in 2007. Those rates are shown on page 13.

The Legislature should establish an 85 percent completion and persistence rate target for nursing programs. THECB should recognize programs that achieve the target or that show significant progress toward the target.

Status: The target was established in rules for the program as described above.

THECB and educational institutions should establish best practices for identifying “at risk” students and

promote those practices through annual student success conferences.

Status: NAHGP funded pilots are testing “at risk” tracking systems through regional consortia in West and East Texas. Preliminary results from those grant projects will be considered at the statewide Partnerships Conference in April, 2009. THECB‟s Advisory Committee on RN Nursing (ACORN) will also be establishing criteria for best practices.

THECB should study existing and alternate methods of program funding to determine the best incentives for schools to increase on-time completion and licensure passage rates.

Status: The $14.7 million Professional Nursing Shortage Reduction Program rewards nursing programs that show increases in graduates from one year to the next.

Appendix B

Executive Summary of A New Curriculum Model for Initial RN Licensure Programs,

(October 2008)

Executive Summary

Senate Bill 139, 80th Texas Legislature, directed the Texas Higher Education Coordinating Board (THECB) in consultation with the Texas Board of Nursing to conduct a study on improving the curricula of professional nursing programs (initial licensure programs). The legislation required the study to focus on methods to improve instruction for providing safe and high quality nursing care to patients.

Patient care and safety have been and continue to be an integral part of nursing education. However, factors other than the way in which nurses are prepared have tremendous effects on the role of nursing in patient safety. Chief among these is the shortage of nurses in health care facilities. Recognizing these other nursing-related factors that affect patient care and safety, the THECB interpreted the directive broadly. As a result, this study considers factors in the curricula that affect both the quality and quantity of nurses produced.

This report summarizes THECB‟s effort to design a “curriculum framework” as Phase 1 in a proposed plan to develop one or more common curriculum models (hereafter referred to as “model”) for the state‟s nursing programs. The curriculum framework identifies the broad conceptual components of nursing education which focus on safety and high quality nursing care. It also incorporates other methods and strategies to support these components and to maximize the potential for enrollment capacity and student success. In this effort to construct the framework, THECB and an external consultant scanned current challenges in Texas, nursing education innovations in Texas, national research contributing to curriculum reform, and other states‟ efforts to develop new curriculum models.

Finally, THECB proposes a plan to further develop the framework into a common curriculum model that, with possible regional modifications, could be implemented at the state‟s 94 initial licensure programs.

Key Findings

The five core competencies described in the Institute of Medicine‟s (IOM) Quality Chasm Series have been almost universally accepted as the broad framework for future health education and for ensuring patient safety in practice settings.

Several states are using the IOM competencies as the framework for designing new curriculum models for initial licensure programs. These state models also are attempting to respond to challenges that are common to nursing education in Texas, including seeking to provide seamless transfer between levels of education and among nursing programs, leveraging limited resources in partnerships among nursing programs and between nursing programs and health care facilities, increasing the use of instructional technology in these programs to maximize the use of classroom and clinical instruction, and increasing enrollment capacity in individual programs.

Texas can use the IOM competencies, the common structural themes currently being tested in other states, and other best practices of the state‟s nursing programs to develop a new curriculum model that could respond to these challenges. However, because of the sheer size of the state and the unique characteristics and resources of nursing programs in specific areas of the state, Texas should establish any new curriculum model on a regional basis. A regional approach would better capitalize on existing partnerships and shared resources, expedite implementation, and coordinate evaluation.

If the Texas Legislature chooses to pursue a new curriculum model for initial RN licensure programs, THECB proposes dividing the process of curriculum development and implementation into three additional phases. Phase 2 (lasting approximately 12 months) would expand the framework into a new curriculum model or models with standard pre-requisites, individual course descriptions, a recommended sequence of courses, and recommended methodologies. It also would require an inventory and assessment of instructional “best practices” of shared faculty and technological resources among nursing programs in the state‟s 10 educational regions. Phase 3 (approximately two to four months) would be the preparation of a final report on the common curriculum model with an implementation plan from each region. Phase 4 would pilot the new curriculum model at nursing programs in at least six of those 10 regions.

Nursing curriculum redesign will require a significant commitment of time and money to achieve

any appreciable results. The State of Oregon appears to lead the nation in developing a statewide curriculum, and its work has inspired similar curricular reform efforts in other states. It implemented a model for 13 initial licensure programs at a cost of $10 million. Most of those costs were associated with developing the curriculum model, redesigning clinical instruction pedagogies, and retraining nursing faculty to the new curriculum. As a result of these curricula innovations and the establishment of two new nursing programs in the state, Oregon has shown an 80 percent increase in nursing enrollments since 2001. Texas enrollments have increased approximately 47 percent for the same period.

State and institutional leaders should anticipate increased programmatic costs during a major transitional period of this kind, particularly in areas associated with faculty development and instructional technology. Health care facilities also should anticipate greater responsibility in nursing education and in transitioning the new graduate to practice.

Recommendations

As a result of this initial study, THECB recommends the following four actions or strategies:

ACTION TO BE TAKEN BY…

ACTIONS/STRATEGIES

Le

gis

latu

re

TH

EC

B

Ed

uca

tio

na

l

In

sti

tuti

on

s

TB

ON

1. Direct THECB to develop the proposed framework

into a new curriculum model for initial licensure

programs as outlined in proposed Phases 2

through 4 and provide funding to support the costs

of consultant services and Phase 4. (THECB

estimates that with in-kind support from

institutions and external support from for-profit

and nonprofit stakeholders, consultant services and

six pilots involving 48 schools, will cost

approximately $15 million.)

X

2. Beginning in September 2009, inventory and

assess local “best practices,” current and future

partnerships, and the potential for sharing faculty

and instructional technology as part of the process

for developing regional pilot proposals in Phase 4.

X X X X

3. Support existing and new partnerships between

nursing programs and health care facilities through state and local initiatives.

X

4. Provide other funding for faculty development

and equipment to support new instructional

methodologies as part of the transition to the new

curriculum model.

X

Key: THECB – Texas Higher Education Coordinating Board TBON – Texas Board of Nursing

Appendix C

Executive Summary of The Feasibility of Sharing Basic Health Science Courses in

Health Education Programs (July 2008)

Executive Summary

Senate Bill 141, 80th Texas Legislature, directed the Texas Higher Education Coordinating Board, in consultation with the Health Professions Council, to study the feasibility of combining basic health science courses within health degree programs at a given institution. The study investigated the feasibility, for example, of combining into a single course two anatomy courses that might otherwise be taught separately in a physical therapy program and in a physician assistant studies program. The text of Senate Bill 141 is provided in Appendix A.

This legislation was motivated by a desire to find solutions to a number of ongoing challenges facing health education programs, especially nursing programs. These challenges include shortages of qualified faculty, program enrollment capacity, and high program costs. In addition, research indicates that health professionals are more effective when working as a team involving multiple health care providers, such as physicians, nurses, therapists, and pharmacists. Research from the Institute of Medicine of the National Academy of Science and from other faculty in Texas suggest that this interdisciplinary approach can be developed by having students from different disciplines work together during their education to gain an understanding and appreciation of the different roles of these health professions. Course sharing among programs could help to foster team-building early in a student‟s education.

As a part of the study, the Coordinating Board staff surveyed 183 degree programs at 37 institutions. The survey included both public and independent universities, health science centers, and community colleges. See Appendix B for a list.

The principal conclusions of the study:

With notable exceptions, relatively few basic health science courses are shared in health education curricula at Texas community colleges, universities, and health science centers.

Course sharing of basic health science courses offers significant benefits in program efficiency and

program quality. There are perceived and real impediments to course sharing. Many institutional impediments can

be resolved with administrative and general academic changes, but external impediments from accreditation and licensure agencies raise concerns which may not have easy solutions. Some of these concerns appear to be unfounded and could be clarified in the rewriting of accreditation and licensure standards. Others are more institution- or discipline-specific and would require further investigation on a case-by-case basis.

A case study showed that despite some institutional and external impediments, course sharing of basic health science courses is feasible if sufficient administrative support, resources, and time are devoted to it.

Although certain model programs have been successful, course sharing is not sufficiently prevalent for the Coordinating Board to recommend specific courses that should be shared statewide or to recommend institutions that should be sharing courses. Institutions should consider greater course sharing in the context of their own unique program offerings, operational policies, and pedagogies.

The concept of interdisciplinary education offers greater possibilities than simply sharing basic health science courses and, in its broadest application, has the potential to improve the quality of health education and health care outcomes in practice settings.

Recommendations

The Coordinating Board recommends the following strategies to increase course sharing of basic health science courses in health education programs:

Because short-term progress is most likely to be achieved at the local level, institutions should evaluate their health education programs to determine if they could be made more efficient or otherwise improved through course sharing.

As appropriate, institutions should eliminate program support policies that might create disincentives for course sharing and establish policies that will create incentives for course sharing.

State licensing boards and agencies should amend their rules and regulations so that they unambiguously allow course sharing of basic health science courses when appropriate.

To provide needed support for the implementation of course sharing of basic health science courses on a statewide basis, the Legislature should provide funding for collaborative efforts, information dissemination, and demonstration grants.

Institutions offering health education programs should actively investigate opportunities to provide interdisciplinary education that might not involve basic health science courses.

Appendix D Institutions Offering Initial Licensure Programs (As of October 2008)

Diploma Programs

Baptist Health System (San Antonio) Covenant School of Nursing (Lubbock)

ADN Programs

Alvin Community College Lone Star College-Montgomery

Amarillo College Lone Star College-North Harris-Meep Angelina College Lone Star College-Tomball

Angelo State University McLennan Community College Austin Community College Midland College

Blinn College Navarro College

Brazosport College North Central Texas College Brookhaven College Northeast Texas Community College

Central Texas College Odessa College Cisco Junior College-Generic/LVN-to-ADN track only Panola College

Coastal Bend College Paris Junior College/LVN-to-ADN track only

College of the Mainland San Antonio College Collin County Community College San Jacinto College-Central

Del Mar College San Jacinto College-South/LVN-to-ADN track only El Centro College South Plains College

El Paso Community College South Texas College Galen College of Nursing Southwest Texas Junior College/LVN-to-ADN track only Galveston College Southwestern Adventist University

Grayson County College St. Phillip‟s College/LVN-to-ADN track only Hill College/LVN-to-ADN track only Tarrant County College

Houston Baptist University Temple College Houston Community College System Texarkana College

Howard College Texas State Technical Jr. College-West Texas/LVN- Kilgore College to-ADN track only Lamar University at Beaumont Trinity Valley Community College

Lamar State College-Orange/LVN-to-ADN track only Tyler Junior College Lamar State College-Port Arthur/LVN-to-ADN track UT at Brownsville & TSMC

only Vernon College Laredo Community College Victoria College

Lee College Weatherford College

Lone Star College-CyFair Wharton County Junior College Lone Star College-Kingwood

BSN Programs

Baylor University Texas Tech University HSC

East Texas Baptist University Texas Woman‟s University

Houston Baptist University University of Houston-Victoria (Sugar Land) Lamar University at Beaumont University of Mary Hardin Baylor

Midwestern State University UT at Arlington Patty Hanks Shelton School of Nursing UT at Austin (also Alternate Entry-MSN program)

(Formerly Abilene Intercollegiate) UT at El Paso

Prairie View A&M University UT at Tyler Southwestern Adventist University UTHSC at Houston

Stephen F. Austin State University UTHSC at San Antonio Tarleton State University UT Medical Branch at Galveston

Texas A&M HSC UT Pan American

Texas A&M International University University of the Incarnate Word

Texas A&M University at Corpus Christi Wayland Baptist University Texas Christian University West Texas A&M University

Appendix E

Additional Maps Showing the Location of Specific Types of Initial Licensure Programs

Appendix F 2007 Graduation Rates by Initial Licensure Program

Number of Graduated Graduated Total Percent Institution

Enrollees 100 % 150 % Graduates Graduated

lvin Community College 78 43 8 51 65.4%

marillo College 202 14 103 117 57.9%

ngelina College 95 54 5 59 62.1%

ngelo State University 96 49 5 54 56.3%

ustin Community College 192 125 10 135 70.3%

aylor University 146 89 40 129 88.4%

linn College 40 26 8 34 85.0%

rookhaven College (DCCD) 30 25 0 25 83.3%

entral Texas College 121 14 13 27 22.3%

ollege of the Mainland 56 23 2 25 44.6%

ollin Co. Community College District 59 41 8 49 83.1%

el Mar College 166 99 19 118 71.1%

ast Texas Baptist University 28 18 7 25 89.3%

l Centro College (DCCD) 308 116 80 196 63.6%

l Paso Community College District 77 28 14 42 54.5%

alveston College 62 40 3 43 69.4%

rayson County College 124 66 18 84 67.7%

ardin-Simmons University 25 18 3 21 84.0%

ouston Community College 291 117 42 159 54.6%

oward College 18 1 7 8 44.4%

ilgore College 56 33 12 45 80.4%

amar State College-Orange 34 32 0 32 94.1%

amar State College-Port Arthur 36 20 6 26 72.2%

amar University 146 24 61 85 58.2%

aredo Community College 49 21 0 21 42.9%

ee College 107 32 8 40 37.4%

one Star College- North Harris 145 88 6 94 64.8%

one Star College-Cy-Fair 29 17 1 18 62.1%

one Star College-Kingwood 29 20 0 20 69.0%

one Star College-Montgomery 51 42 0 42 82.4%

one Star College-Tomball 50 40 1 41 82.0%

cLennan Community College 123 80 10 90 73.2%

idland College 80 65 5 70 87.5%

idwestern State University 122 35 28 63 51.6%

avarro College 45 25 0 25 55.6%

orth Central Texas College 45 36 1 37 82.2%

ortheast Texas Community College 28 12 0 12 42.9%

dessa College 117 50 19 69 59.0%

anola College 58 10 9 19 32.8%

aris Junior College 60 35 0 35 58.3%

rairie View A&M University 129 0 61 61 47.3% an Antonio College 417 290 48 338 81.1%

A

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G

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Number of Graduated Graduated Total Percent Institution

Enrollees 100 % 150 % Graduates Graduated

San Jacinto College Central Campus 102 45 14 59 57.8%

San Jacinto College South Campus 78 33 10 43 55.1%

South Plains College 110 27 25 52 47.3%

South Texas College 94 64 14 78 83.0%

Southwestern Adventist University 62 18 0 18 29.0%

Stephen F. Austin State University 78 56 14 70 89.7%

Tarleton State University 97 12 32 44 45.4%

Tarrant Co. College South Campus 174 138 12 150 86.2%

Temple College 49 39 2 41 83.7%

Texarkana College 100 55 6 61 61.0%

Texas A&M International University 33 0 19 19 57.6%

Texas A&M University-Corpus Christi 87 52 15 67 77.0%

Texas Christian University 126 33 75 108 85.7%

Texas Southmost College 119 73 20 93 78.2%

Texas Tech University HSC 170 9 146 155 91.2%

Texas Woman's University 398 232 84 316 79.4%

Trinity Valley Community College 133 70 12 82 61.7%

Tyler Junior College 84 64 9 73 86.9%

University of the Incarnate Word 64 2 34 36 56.3%

UT at Arlington 185 134 29 163 88.1%

UT at Austin 119 114 3 117 98.3%

UT at El Paso 145 30 67 97 66.9%

UT at Tyler 130 53 43 96 73.8%

UT Medical Branch at Galveston 114 84 8 92 80.7%

UTHSC-Houston 132 105 12 117 88.6%

UTHSC-San Antonio 165 105 29 134 81.2%

UT-Pan American 74 37 8 45 60.8%

Vernon College 101 76 1 77 76.2%

Victoria College 97 59 15 74 76.3%

Weatherford College 48 25 5 30 62.5%

West Texas A&M University 99 1 51 52 52.5%

Wharton County Junior College 35 26 1 27 77.1%

Total 7,772 3,884 1,486 5,370 69.1%


Appendix G Six-Year Graduation Trend Analysis by Initial Licensure Program

7- Yr Net 3-Yr Net 7-Yr % 3-Yr %

Change Change Change Change

2001-2007 2004-2007 2001:2007 2004:2007

Baptist Health System 59 67 8 63 -4 57 -6 43 -14 79 36 99 20 40 36 68% 74%

Covenant School of Nursing 59 69 10 92 23 93 1 137 44 90 -47 80 -10 21 -12 36% -14%

Diploma Totals 118 136 18 155 19 150 -5 180 30 169 -11 179 10 61 24 52% 19%

Alvin Community College 42 31 -11 41 10 52 11 59 7 55 -4 51 -4 9 10 21% -2%

Amarillo College 90 94 4 90 -4 114 24 124 10 132 8 128 -4 38 38 42% 12%

Angelina College 40 47 7 58 11 71 13 67 -4 76 9 54 -22 14 -4 35% -24%

Angelo State University 45 42 -3 44 2 76 32 71 -5 90 19 64 -26 19 20 42% -16%

Austin Community College 94 107 13 119 12 147 28 134 -13 180 46 146 -34 52 27 55% -1%

Blinn College 35 37 2 51 14 49 -2 36 -13 65 29 66 1 31 15 89% 35%

Central Texas College 52 52 0 102 50 86 -16 70 -16 86 16 65 -21 13 -37 25% -24%

Cisco Junior College 29 28 -1 39 11 34 -5 32 -2 34 2 53 19 24 14 83% 56%

College of the Mainland 17 0 -17 4 4 13 9 13 0 28 15 24 -4 7 20 41% 85%

Collin County College 35 33 -2 41 8 46 5 48 2 44 -4 58 14 23 17 66% 26%

Del Mar College 119 110 -9 121 11 131 10 133 2 151 18 136 -15 17 15 14% 4%

El Centro College 134 128 -6 160 32 141 -19 167 26 231 64 262 31 128 102 96% 86%

El Paso Community College 63 51 -12 56 5 61 5 84 23 72 -12 91 19 28 35 44% 49%

Galveston College 64 39 -25 42 3 57 15 68 11 70 2 63 -7 -1 21 -2% 11%

Grayson County College 81 92 11 92 0 81 -11 67 -14 84 17 76 -8 -5 -16 -6% -6%

Hilll College 18 18 18 18 n/a n/a

Houston Baptist University 15 18 3 9 -9 11 2 6 -5 6 0 3 -3 -12 -6 -80% -73%

Houston Community College 104 118 14 117 -1 86 -31 149 63 139 -10 143 4 39 26 38% 66%

Howard College 5 7 2 20 13 10 -10 9 -1 11 2 8 -3 3 -12 60% -20%

Kilgore College 24 43 19 54 11 43 -11 46 3 49 3 87 38 63 33 263% 102%

Lamar State College-Orange 48 50 2 21 -29 29 8 37 8 32 -5 32 0 -16 11 -33% 10%

Lamar State College-Port Arthur 30 24 -6 32 8 30 -2 25 -5 27 2 34 7 4 2 13% 13%

Lamar University-Beaumont 36 29 -7 49 20 50 1 38 -12 34 -4 29 -5 -7 -20 -19% -42%

Laredo Community College 39 42 3 61 19 50 -11 22 -28 24 2 28 4 -11 -33 -28% -44%

Lee College 25 33 8 41 8 39 -2 41 2 59 18 65 6 40 24 160% 67%

McClennan CC-Waco 91 100 9 104 4 113 9 136 23 113 -23 104 -9 13 0 14% -8%

Midland College 31 26 -5 33 7 47 14 66 19 75 9 76 1 45 43 145% 62%

Navarro College 24 39 15 28 -11 38 10 30 -8 28 -2 31 3 7 3 29% -18%

North Central Texas College 51 41 -10 54 13 56 2 54 -2 70 16 70 0 19 16 37% 25%

North Harris Montgomery CC 110 103 -7 132 29 168 36 152 -16 247 95 288 41 178 156 162% 71%

NE Texas Community College 19 20 1 25 5 22 -3 19 -3 16 -3 24 8 5 -1 26% 9%

Odessa College 33 51 18 82 31 63 -19 46 -17 69 23 42 -27 9 -40 27% -33%

Panola College 23 14 -9 26 12 38 12 26 -12 25 -1 47 22 24 21 104% 24%

Paris Junior College 33 25 -8 43 18 57 14 46 -11 42 -4 57 15 24 14 73% 0%

San Antonio College 191 188 -3 194 6 253 59 287 34 298 11 326 28 135 132 71% 29%

San Jacinto College -Central 133 106 -27 120 14 132 12 179 47 149 -30 135 -14 2 15 2% 2%

San Jacinto College-South 62 47 -15 67 20 70 3 61 -9 60 -1 62 2 0 -5 0% -11%

South Plains College 39 31 -8 37 6 42 5 66 24 79 13 81 2 42 44 108% 93%

South Texas CC 40 53 13 93 40 106 13 112 6 109 -3 134 25 94 41 235% 26%

Southwestern Adventist Univ 31 27 -4 13 -14 31 18 28 -3 25 -3 34 9 3 21 10% 10%

St Philip's College 20 16 -4 19 3 47 28 58 11 68 10 65 -3 45 46 225% 38%

Tarrant County College 127 141 14 141 0 141 0 127 -14 153 26 168 15 41 27 32% 19%

Temple College 40 33 -7 36 3 42 6 44 2 45 1 62 17 22 26 55% 48%

Texarkana College 66 68 2 65 -3 70 5 59 -11 74 15 65 -9 -1 0 -2% -7%

Trinity Valley CC 71 61 -10 82 21 68 -14 88 20 85 -3 120 35 49 38 69% 76%

Tyler Junior College 59 48 -11 62 14 71 9 71 0 74 3 75 1 16 13 27% 6%

UT-Brownsville/TX Southmost 30 18 -12 77 59 72 -5 57 -15 90 33 112 22 82 35 273% 56%

Vernon College 47 56 9 68 12 66 -2 66 0 93 27 71 -22 24 3 51% 8%

Victoria College 50 79 29 77 -2 70 -7 76 6 80 4 76 -4 26 -1 52% 9%

Weatherford College 0 25 25 32 7 50 18 55 5 28 -27 36 8 36 4 n/a -28%

Wharton County Junior College 27 26 -1 39 13 42 3 25 -17 30 5 28 -2 1 -11 4% -33%

ADN Totals 2714 2697 -17 3213 516 3482 269 3580 98 4004 424 4173 169 1459 960 54% 20%

2006

Total

Grads

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2001

Total

Grads

2002

Total

Grads

2003

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Grads

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2007

Total

Grads

2004

Total

Grads

2005

Total

Grads

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change

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7- Yr Net 3-Yr Net 7-Yr % 3-Yr %

Change Change Change Change

2001-2007 2004-2007 2001:2007 2004:2007

Abilene Intercollegiate 33 34 1 43 9 42 -1 56 14 54 -2 65 11 32 22 97% 55%

Baylor University 96 87 -9 100 13 84 -16 108 24 127 19 123 -4 27 23 28% 46%

East Texas Baptist University 12 20 8 17 -3 21 4 18 -3 24 6 15 -9 3 -2 25% -29%

Houston Baptist University 35 26 -9 19 -7 15 -4 31 16 17 -14 21 4 -14 2 -40% 40%

Lamar University-Beaumont 33 49 16 44 -5 40 -4 43 3 55 12 63 8 30 19 91% 58%

Midwestern State University 34 26 -8 28 2 42 14 40 -2 68 28 68 0 34 40 100% 62%

Prairie View A&M University 62 67 5 58 -9 59 1 40 -19 70 30 81 11 19 23 31% 37%

Southwestern Adventist U 33 33 33 33 n/a n/a

Stephen F Austin State Univ 40 33 -7 34 1 58 24 60 2 78 18 77 -1 37 43 93% 33%

Tarleton State University 12 29 17 23 -6 32 9 30 -2 57 27 42 -15 30 19 250% 31%

Texas A&M International-Laredo 21 20 -1 27 7 32 5 23 -9 29 6 38 9 17 11 81% 19%

Texas A&M Univ-Corpus Christi 41 37 -4 45 8 47 2 60 13 67 7 97 30 56 52 137% 106%

Texas Christian University 68 62 -6 45 -17 77 32 97 20 146 49 91 -55 23 46 34% 18%

Texas Tech University HSC 73 82 9 102 20 120 18 124 4 174 50 212 38 139 110 190% 77%

Texas Womans University 220 204 -16 227 23 286 59 302 16 295 -7 301 6 81 74 37% 5%

University of Mary Hardin Baylor 29 43 14 47 4 53 6 62 9 63 1 64 1 35 17 121% 21%

UT-Arlington 151 169 18 170 1 183 13 177 -6 161 -16 182 21 31 12 21% -1%

UT-Austin 87 90 3 96 6 94 -2 110 16 131 21 112 -19 25 16 29% 19%

UT-El Paso 83 72 -11 124 52 142 18 123 -19 107 -16 137 30 54 13 65% -4%

UT-Tyler 150 118 -32 102 -16 101 -1 108 7 177 69 180 3 30 78 20% 78%

UT-HSC-Houston 68 79 11 105 26 107 2 126 19 139 13 134 -5 66 29 97% 25%

UT-HSC-San Antonio 111 190 79 198 8 195 -3 251 56 150 -101 193 43 82 -5 74% -1%

UT-MB-Galveston 69 85 16 83 -2 84 1 119 35 125 6 105 -20 36 22 52% 25%

UT-Pan American 45 44 -1 38 -6 48 10 68 20 46 -22 71 25 26 33 58% 48%

University of Incarnate Word 41 40 -1 38 -2 42 4 27 -15 42 15 39 -3 -2 1 -5% -7%

West Texas A&M University 58 56 -2 51 -5 23 -28 48 25 75 27 98 23 40 47 69% 326%

BSN Totals 1672 1762 90 1864 102 2027 163 2251 224 2477 226 2642 165 970 778 58% 30%

UT-Austin Alternate Entry MSN 27 14 -13 11 -3 18 7 18 0 24 6 37 13 10 26 37% 106%

MSN Totals 27 14 -13 11 -3 18 7 18 0 24 6 37 13 10 26 37% 106%

Basic Nursing Program Totals 4531 4609 78 5243 634 5677 434 6029 352 6674 645 7031 357 2500 1788 55% 24%

Annual Percentage Increase 1.7 13.8 8.3 6.2 10.7 5.3

2007 Adjustments:

BROOKHAVEN COLLEGE 29

CY FAIR COLLEGE (NHMCCD) 21

KINGWOOD COLLEGE (NHMCCD) 65

MONTGOMERY COLLEGE (NHMCCD) 50

TOMBALL COLLEGE (NHMCCD) 43

2006

Total

Grads

Sources: Texas Board of Nursing, Texas Center for Nursing Workforce Studies, and Coordinating Board.

Included in North Harris Montgomery CC Total Grads -2007

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2002

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2003

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2004

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2005

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Included in El Centro College Total Grads -2007

Included in North Harris Montgomery CC Total Grads - 2007

Included in North Harris Montgomery CC Total Grads - 2007

Included in North Harris Montgomery CC Total Grads -2007

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Appendix H Detailed Educational Pipeline by Degree Level

1 Many schools have special tracks for LVNs and paramedics. Seven of the ADN schools only have LVN to RN programs. 2 Percentage is average percent of students that complete nursing program within 150 percent time of initial enrollment.

Source: Prepared by the Texas Nurses Association and adapted for publication by the Coordinating Board.

LICENSING EXAM (NCLEX) 2007 Pass Rate: >90%

QUALIFIED APPLICANTS Fall 2007: 19,035

OFFERED ADMISSION Fall 2007: 11,270

INITIAL RN GRADUATES

HOSPITAL OTHER SETTINGS

TOTAL INITIAL LICENSURE RN STUDENTS Fall 2007: 17,836

BSN (22) (4 Yr Coll/Univ)

Total: 5,869 Unlic: 5,757 LVN

1: 105

EMS1: 7

ADN (57) (Comm College)


1: 1,545

EMS1: 92

ALT MSN (1) (4Yr & HSC)

Total: 145 Unlic: 145 LVN: 0 EMS: 0

BSN (4) (Health Sci Ctr)


1: 39

EMS1: 1

DIPLOMA (2) (Hospital)

Total: 505 Unlic: 460 LVN

1: 44

EMS1: 1

RETURNING STUDENTS Fall 2007: 7,830

NEW ENROLLEES Fall 2007: 10,006

RN LICENSURE

Est 70%

56% 33% 7% 1% 3%

Est 30%

66% Est Avg Grad Rate

2 72% Est Avg Grad Rate

2 86% Est Avg Grad Rate

2

EMPLOYMENT

Appendix I Institutions Offering Master of Science in Nursing by Program Type

Master of Science in Nursing

Nursing Administration Programs Lamar University Midwestern State University Prairie View A&M University Texas A&M University - Corpus Christi Texas Tech University Health Sciences Center Texas Woman‟s University, Houston campus University of Houston – Victoria University of Texas at Arlington University of Texas at Austin University of Texas at Brownsville University of Texas at El Paso

University of Texas Health Science Center at Houston

University of Texas Health Science Center at San Antonio

University of Texas Medical Branch at Galveston University of Texas at Pan American University of Texas at Tyler West Texas A&M University Lubbock Christian University Patty Hanks-Shelton School of Nursing *

* A consortium of Abilene Christian, Hardin-Simmons, and McMurry Universities

Post-Master‟s Certificate Nursing Administration Programs

University of Texas at El Paso University of Texas Health Science Center at Houston

Master of Science in Nursing Nursing Education Programs

Angelo State University Lamar University Midwestern State University Prairie View A&M University Texas A&M University Corpus Christi Texas Tech University Health Sciences Center University of Houston - Victoria University of Texas at Austin University of Texas at Brownsville

University of Texas at El Paso University of Texas Medical Branch at Galveston University of Texas at Pan American University of Texas at Tyler West Texas A&M University Lubbock Christian University Patty Hanks-Shelton School of Nursing * Texas Christian University University of Mary-Hardin Baylor

* A consortium of Abilene Christian, Hardin-Simmons, and McMurry Universities

Post-Master‟s Certificate Nursing Education Programs

Angelo State University Texas Woman‟s University, Dallas campus Texas Woman‟s University, Denton campus Texas Woman‟s University, Houston campus University of Texas at Arlington

University of Texas at El Paso University of Texas at Tyler University of Texas Health Science Center at

San Antonio Baylor University


Advanced Practice Nursing Programs and Nurse Practitioner Specialization Area

Midwestern State University (Family Nurse Practitioner) Prairie View A&M University (Family Nurse Practitioner) Texas A&M International University (Family Nurse Practitioner) Texas A&M University Corpus Christi (Family Nurse Practitioner) Texas Tech University Health Sciences Center (Acute Care, Family, Gerontological, and Pediatric

Nurse Practitioner) Texas Woman‟s University, Denton campus (Family Nurse Practitioner) Texas Woman‟s University, Dallas campus (Adult, Family, Pediatric, and Women‟s Health Care Nurse

Practitioner) Texas Woman‟s University, Houston campus (Acute Care, Adult, Family, and Pediatric Nurse

Practitioner) University of Texas at Arlington (Acute Care, Acute Care Pediatrics, Adult, Emergency, Family,

Gerontological, Pediatric and Psychiatric/Mental Health Nurse Practitioner) University of Texas at Austin (Family, Neonatal, and Pediatric Nurse Practitioner) University of Texas at El Paso (Family and Women‟s Health Care Nurse Practitioner) University of Texas Health Science Center at Houston (Acute Care, Adult, Emergency, Gerontological,

Women‟s Health, Family, and Pediatric Nurse Practitioner) University of Texas Health Science Center at San Antonio (Acute Care, Psychiatric/Mental Health,

Gerontological, and Pediatric Nurse Practitioner) University of Texas Medical Branch at Galveston (Acute Care, Neonatal, Gerontological, Family, and

Pediatric Nurse Practitioner) University of Texas at Pan American (Family and Pediatric Nurse Practitioner) University of Texas at Tyler* (Acute Care, Pediatric, Gerontological, and Family Nurse Practitioner) West Texas A&M University (Family Nurse Practitioner) Baylor University (Family Nurse Practitioner) Patty Hanks Shelton School of Nursing** (Family Nurse Practitioner) *Collaborative program with Texas Tech University Health Sciences Center ** A consortium of Abilene Christian, Hardin-Simmons, and McMurry Universities

Post-Master‟s Certificate Nurse Practitioner Programs

Texas Woman‟s University, Dallas campus (Adult, Family, Pediatric, and Women‟s Health Care Nurse Practitioner)

Texas Woman‟s University, Houston campus (Adult and Family Nurse Practitioner) University of Texas at Arlington (Acute Care, Acute Care Pediatrics, Emergency, Family, and

Psychiatric/Mental Health Nurse Practitioner) University of Texas at Austin (Family and Pediatric Nurse Practitioner) University of Texas at El Paso (Family Nurse Practitioner) University of Texas Health Science Center at Houston (Acute Care, Adult, Emergency, Gerontological,

Women‟s Health, Family and Pediatric Nurse Practitioner) University of Texas Medical Branch at Galveston (Acute Care, Neonatal, Gerontological, Family, and

Pediatric Nurse Practitioner) Patty Hanks Shelton School of Nursing (Family Nurse Practitioner)


Advanced Practice Nursing Programs Clinical Nurse Specialist

Angelo State University (Adult Health) Texas A&M University Corpus Christi Texas Woman‟s University, Dallas campus (Child Health) Texas Woman‟s University, Houston campus ( Adult Health) University of Texas at Austin (Holistic Adult Health) University of Texas Health Science Center at Houston (Acute Care, Adult, Gerontological, Psychiatric/Mental Health, Women‟s Health Care) University of Texas Health Science Center at San Antonio (Critical Care, Medical-Surgical) University of Texas Medical Branch at Galveston (Acute Care, Neonatal, Gerontological, Family and Pediatric Nurse Practitioner) University of Texas at Pan American (Adult Health) Texas Christian University (Adult Health) University of the Incarnate Word

Post-Master‟s Certificate Clinical Nurse Specialist Programs

Angelo State University (Adult Health) Texas Woman‟s University, Houston campus (Adult Health) University of Texas Health Science Center at Houston (Critical Care, Adult Health)

Appendix J

Institutions That Submitted Incomplete or No Data for Graduate Programs

Master‟s programs submitting incomplete or no data:

Lubbock Christian University Patty Hanks-Shelton School of Nursing Prairie View A&M University Texas Wesleyan University of Texas at Brownsville University of Texas at Pan American University of Texas at Tyler University of Texas Health Science Center – San Antonio University of Texas Medical Branch University of the Incarnate Word West Texas A&M University

Schools with Nursing Educator programs submitting incomplete or no data: University of Texas at Brownsville University of Texas Health Science Center at San Antonio University of Texas Medical Branch

Schools with Advanced Nursing Practice programs submitting incomplete or no data: Patty Hanks-Shelton School of Nursing Texas Wesleyan University of Texas at Brownsville University of Texas at Pan American University of Texas at Tyler

Schools with Nursing Administration programs submitting incomplete or no data:

Lubbock Christian University Prairie View A&M University University of the Incarnate Word West Texas A&M University

Appendix K

Practice Salary Data by Job Title and Texas Location (2008)

TEXAS - NURSE PRACTITIONERS TEXAS - HEAD NURSE - EMERGENCY ROOM

25th% 75th% 25th% 75th%

Brownsville $64,387 Houston $89,909 Brownsville $64,534 Houston $101,124

El Paso $66,349 Dallas $88,569 El Paso $66,501 Dallas $99,617

Waco $67,197 Fort Worth $85,678 Waco $67,351 Fort Worth $96,365

Abilene $67,353 Austin $85,476 Abilene $67,507 Austin $96,139

Amarillo $68,163 San Antonio $82,708 Amarillo $68,319 San Antonio $93,025

San Antonio $70,493 Amarillo $80,316 San Antonio $70,354 Amarillo $90,335

Austin $72,543 Abilene $79,361 Austin $72,709 Abilene $89,261

Fort Worth $72,714 Waco $79,177 Fort Worth $72,880 Waco $89,054

Dallas $75,167 El Paso $78,179 Dallas $75,339 El Paso $87,931

Houston $76,305 Brownsville $75,866 Houston $76,749 Brownsville $85,330

TEXAS - CLINICAL NURSE SPECIALISTS TEXAS - HEAD NURSE - INTENSIVE CARE UNIT

25th% 75th% 25th% 75th%











TEXAS - HEAD NURSE TEXAS - HEAD NURSE - OPERATING ROOM

25th% 75th% 25th% 75th%











TEXAS - HEAD NURSE - CCU TEXAS - TRANSPLANT NURSE COORDINATOR

25th% 75th% 25th% 75th%











TEXAS - NURSING EDUCATION COORDINATOR TEXAS - HEAD NURSE PSYCHIATRIC UNIT

25th% 75th% 25th% 75th%

Abilene $53,933 Houston $80,225 Brownsville $61,594 Houston $97,410

Brownsville $56,612 Dallas $79,029 El Paso $63,472 Dallas $95,957

El Paso $58,338 Fort Worth $76,449 Waco $64,282 Austin $92,607

Waco $59,083 Austin $76,269 Abilene $64,432 Fort Worth $92,560







Source: Salary.com.

Salary.com is used by the Texas Center for Nursing Workforce Studies and other states‟ nursing centers to compare state and national nursing

salaries. The site has 7,000 corporate subscribers and data resources representing 10 million employees. The data offered through the site

are compiled from employer –reported market surveys and proxy data that have been verified by certified compensation professionals.

Appendix L

Projects Funded under the

2008-09 Nursing, Allied Health, and Other Health Education Grant Program

The Board awarded 13 grants, totaling $4,240,916: Academic and Clinical Partnerships Competition (10, two-year grants) Aalund, Peggy and Irwin, Marsha, Lone Star College - Kingwood in partnership with Kingwood Medical Center Hospital (HCA), Memorial Hermann-The Woodlands, Memorial Hermann-Northeast, Course Redesign for Self-Paced Nursing Students. $298,561. Shortages of nurse educators, student attrition and limited enrollment contribute to the nursing shortage. This project will develop an online, self-paced, precepted, initial licensure RN program to increase student flexibility, extend nurse educators, and increase students‟ financial resources. Goals are to redesign curricula, increase clinical capacity, provide a flexible format, and develop work-study partnerships. Phase 1 will include development of modules and hospital partnerships. Phase 2 will be finalizing online courses and identifying students for two cohorts: second degree or LVN-RN Transition students. Implementation begins August 2008. Evaluation of results will include participant satisfaction, retention, clinical performance and NCLEX results. Cannon, Sharon and Allen, Patricia, Texas Tech University Health Sciences Center in partnership with Angelo State University, Midwestern State University, The University of Texas El Paso, West Texas A&M University, Cisco Junior College, El Paso Community College, Midland College, Odessa College, South Plains College, Vernon College, and American State Bank, West Texas Nursing Education Portal Project (WTNEPP) $298,411. Lack of a standardized application for nursing schools results in duplication of applications, vacant admission slots and the inability to utilize resources to assess, track and retain “at risk” students. The West Texas Nursing Education Portal Project goals are to develop a central application portal and a Regional Retention Initiative to increase graduation rates for schools in the West Texas Nursing Education Consortium. The project objectives are to match student applications with schools, develop a centralized database, track applicants and develop a central retention portal. Project evaluation will be based on cost, vacant slots, increased enrollments and graduation rates. Diaz, Mary I. and Otto, Debra, The University of Texas - Pan American in partnership with McAllen Medical Center, Edinburg Regional Medical Center, Doctor's Hospital at Renaissance, An Academic Retention Model for Baccalaureate Nursing Students- A Multifaceted Collaboration Approach for the South Texas Region. $278,781. The project will address the question: Does identification of scholastic aptitude serve as an early predictor of success in the nursing curriculum? The goals and objectives are to increase enrollment by 10%, identify students risk for incompletion, promote student success, utilize collaborative teaching/clinical preceptors, and increase retention by 20%. Project activities will include increasing enrollment by 10%, identifying at risk students, retaining students through remediation, and identifying and remediating failing students. Quantitative and qualitative methodologies will be used to determine

if the identification of scholastic aptitude serves as an early academic predictor of success, and whether the remediation program and clinical preceptors added to student success. Etzel, Judy and Hobbins, Bonnie, Lee College in partnership with San Jacinto Methodist Hospital, Streamlined Track of Academics for RN-Transitional at the Work Place: START at the Work Place. $273,144. A community hospital joined forces with the local community college to provide a RN- Transitional program for the LVN staff. Classes will be broadcast to the work site. Hospital staff RN preceptors will work with the students in clinical, supervised by an A.D.N. faculty, serving as a “Coach” to facilitate the students‟ success. Goals for this project include: (1) Increase the number of students admitted to the RN-Transitional track; (2) Redesign courses to streamline the RN-Transitional degree plan; and (3) Evaluate the effectiveness of the course redesign for the degree plan. Course exams, standardized testing and NCLEX-RN pass rate will be used to evaluate the success of these efforts. Fontenot, Debra L. and Durand, Sally, Alvin Community College in partnership with Texas Children's Hospital, Partnership in Academic and Clinical Excellence (PACE). $66,345. Barriers identified to increasing nursing graduates include lack of clinical sites and failure in didactic courses. A model of delivering pediatric course content in a manner that meets course objectives, maximizes student retention, and provides alternative sites for clinical education will be developed. Activities include frontloading of didactic content, providing simulation in the lab, and utilizing acute care and community-based settings for clinical. A lab coordinator will supervise lab and provide remediation. Evaluation methodology includes results of a clinical-site survey, student retention rates, and student performance on HESI. Hamilton, Marilyn, Victoria College in partnership with Citizen's Medical Center, University of Houston-Victoria, DeTar Health Care System, Preparing Certified Clinical Instructors. $150,324. One of the main factors contributing to the current nursing shortage is the shortage of nursing faculty. The goal of the Certified Clinical Instructor (CCI) Project is to increase the number of qualified clinical faculty by demonstrating that BSN prepared nurses with a minimum of three years clinical experience can, with two post-graduate nursing education courses, become qualified to teach Associate Degree Nursing (ADN) students in the clinical setting. These CCIs will provide clinical instruction to ADN students from summer 2008 through spring 2009. These students will be compared to ADN students who are being taught by master‟s prepared clinical instructors from the Victoria College ADN faculty. Evaluation of the project will compare course grades, clinical performance as measured by the clinical evaluation tool, standardized test scores and ultimately NCLEX-RN pass rates of students who receive clinical instruction from specially prepared BSN clinical instructors with those who have Master‟s prepared clinical instructors. Klein, Eileen and Ward, Jean, Austin Community College District in partnership with Seton Family of Hospitals, St. David's Healthcare Institute of Learning, and Capital IDEA, Student Tracking and Retention Project (STAR), a Program for Intervention and Retention of At-risk Nursing Students. $196,903. The STAR program will target student attrition to address the increased need for nurses created by facility growth and workforce shortages. Intake assessments/analysis of risk and standardized intervention algorithms will be used to determine and address high risk. Tracking will enable sustained

engagement with project students. Tutoring, other interventions, and presentations from diverse and successful nursing role models will improve student determination/retention. Goals/objectives: a 10% increase in student retention; a 20% increase among more diverse students; and a 10% increase in HESI exit exam scores above 800. Program evaluation includes data collection on interventions, student outcomes and student satisfaction and identification of best practices. Richard, Patricia and Brooke, Virginia, The University of Texas Medical Branch at Galveston in partnership with The Methodist Hospital, Statewide Collaborations in Clinical Placement. $219,707. To meet the goals for increasing the number of registered nurses in the workforce, an efficient method of managing clinical placements is essential to increase the capacity for enrollment. In 2007 the Gulf Coast region implemented the Centralized Clinical Placement System (CCPS) to streamline and facilitate the process and identify underutilized clinical placements. Goals of this project include identifying a region for expansion and implementing the CCPS. After selecting a region for expansion of the CCPS, an on-site team will be identified and trained to recruit schools of nursing and clinical agencies, maximizing collaboration and increasing clinical placement availability. Sheriff, Susan and Chaney, Susan, Texas Woman's University in partnership with Baylor University Medical Center–Dallas, Reinventing Nursing Education: An Education and Practice Partnership. $249,777. This project addresses the problem of the Texas nursing shortage. The goals of the project are to increase the number of registered nurses in Texas, enhance the availability of nursing as a career to individuals with a non-nursing-baccalaureate degree through a weekend/online undergraduate nursing program, and demonstrate a partnership between Texas Woman‟s University and Baylor University Medical Center (BUMC). BUMC will provide weekend clinical experiences and nursing faculty. Implementation of the project involves the recruitment, education, and retention of nursing students. Evaluation of the project is the successful graduation and licensure of 20 nursing students by May 2010. Walker, Glenda C., Stephen F. Austin State University in partnership with Angelina College, Kilgore College, Northeast Texas Community College, Panola College, Texarkana College, Trinity Valley Community College, Tyler Junior College, and The University of Texas at Tyler, A Research Model for Identifying and Intervening with At-Risk Nursing Students. $265,970. Nine nursing programs in the Region 4 Nursing Education Consortium will address the problem of attrition. Specific objectives are to develop shared resources, including: (1) a centralized student database which addresses background, academic, and environmental variables; (2) protocols for identifying at-risk students at the point of entry into the partnering programs; (3) standardized intervention protocols for those students; and (4) to assess effectiveness of the intervention protocols in retaining those students. Various intervention modes will be used to address academic and environmental variables related to attrition. These modes will include web-based modules and interactive discussion boards. Quantitative and qualitative data will be used to evaluate program effectiveness.

Hospital Partnerships Competition (Two, three-year grants) Mancini, Mary E., The University of Texas at Arlington in partnership with Texas Health Resources (THR), The LEARN (Leveraging Existing Academic Resources in Nursing) Project: Experiential Learning Through a Synergistic Hospital-Based Accelerated BSN Program. $577,287. LEARN proposes a 15- (versus 21-24) month BSN program that leverages existing faculty and hospital-based resources to overcome enrollment constraints (classroom size, faculty, clinical sites), impact graduation (work conflicts), and prolong hospital orientations (limited clinical exposure). Students (THR employees) will access course content at times, places, rates that meet learning needs and work demands (Pod-casts); complete clinicals supervised by THR nurses serving as faculty; and receive support from specially-prepared THR nurses acting as hospital-based facilitator/coaches. Evaluation of this structured academic-hospital partnership model will include comparison to traditional BSN outcomes and cost-benefit assessment from the perspective of students, employer, and School of Nursing. Mayrand, Leslie M., Angelo State University in partnership with Shannon Medical Center, San Angelo Community Medical Center, Brownwood Medical Center, and Scenic Mountain Medical Center, Transforming LVN-RN Education Through Hospital Partnerships. $1,270,897. The LVN-RN transition model of education is antiquated, inefficient, & costly. As a result 77,000+ LVNs in Texas remain virtually “untapped” in solving the RN shortage. In partnership with four West Texas hospitals, ASU proposes the development and implementation of a new model of LVN-RN education including: (1) a 50% decrease in completion time; (2) didactic content delivered and evaluated through blending of online and printed study modules; (3) clinical experiences at place of employment; (4) paid release time by hospital employer: and (5) adoption of a LVN-RN competency transcript. Evaluation will be done via NCLEX pass rates, satisfaction surveys, graduation data, and cost analyses. Conference on Partnerships (1, Two-year grant) Hanley, Mary Anne and Allen, Patricia, Texas Tech University Health Sciences Center in partnership with South Plains Nursing Education Community Coalition: TTUHSC; Covenant School of Nursing; South Plains College; Lubbock Christian University; American State Bank; WorkSource; University Medical Center; and Covenant Health System, and National League of Nursing, We Can Do It Together: A Mosaic of Partnerships, April 2-4, 2009. $94,809. The three-day conference allows West Texas to share national and regional success stories while highlighting lessons learned from partnerships. Goal 1 is to present findings on intercollegiate and hospital partnerships that have improved graduation rates in initial RN-licensure programs. Invited presentations from partnerships between academic institutions and hospitals resulting in increased enrollment/graduations will be shared. Goal 2 is to provide opportunities for attendees to discuss new ideas for implementing and sustaining these partnerships. Goal 3 is to foster collaboration among all levels of nursing education by “Deep Dives”. The attendees‟ post conference survey results will constitute the evaluation component of the grant.

This document is available on the Texas Higher Education Coordinating Board website: http://www.thecb.state.tx.us For more information, contact:

Chris Fowler, Senior Program Director Donna Carlin, Program Director

Texas Higher Education Coordinating Board P.O. Box 12788

Austin, TX 78711

512/427-6101

Strategies to Increase the Number of Initial Licensure Registered Nurses and Nursing Faculty

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