Nursing Education and the Decade of Change: Strategies to Meet America’s Health Needs reports on the strides made especially in the past 10 years thanks to the Robert Wood Johnson Foundation Academic Progression in Nursing (APIN) program and the RWJF Future of Nursing State Implementation Program (SIP). The Compendium  is intended to be a toolkit, too, so other schools of nursing and businesses can build on what APIN and SIP have learned to expand the work. APIN was coordinated by the Tri-Council for Nursing; SIP by the Center to Champion Nursing in America, at AARP’s Public Policy Institute.

Landscape PDF

Portrait PDF

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• Affirm areas of mutual understanding.
• Seek clarity on specific issues related to academic progression.
• Identify how regulations related to academic progression are communicated.
• Identify an appropriate dissemination strategy including an FAQ document and follow-up webinar.

The discussion included an overview of the issues raised by the APIN and State Implementation Program (SIP) grantees working on academic progression models nationally. The group developed a set of responses to frequently asked questions. See the document below.

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Accreditation-and-Academic-Progression-FAQs.pdf

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The nursing profession, with nearly 3 million licensed and practicing nurses in the United States, comprises the largest segment of the nation’s health care workforce. There is consensus among experts that nursing education should be modernized to train a greater percentage of nurses at the graduate level and provide the skills nurses need as today’s health care delivery system continues to evolve towards more team-based, data-driven, and coordinated care.

The Alliance for Health Reform, AARP, and the Robert Wood Johnson Foundation sponsored a briefing on Graduate Nursing Education on Wednesday, January 21.

The panelists addressed the following questions:

• What does the nursing workforce look like now and how does it need to change to meet current and future health needs in the U.S.?
• How are nursing education and training currently financed?
• What is the role of federal policy in training a 21st century nursing workforce?
• How does the nursing workforce fit into today’s primary care workforce and the evolving health care delivery system?

Watch the Briefing:

Materials handed out at the briefing can be found here.

Panelists:

Linda H. Aiken, (@LindaAiken_Penn) Claire M. Fagin leadership professor in nursing, professor of sociology, and director of the Center for Health Outcomes and Policy Research, University of Pennsylvania, will describe a new graduate nursing education demonstration being conducted through the Center for Medicare and Medicaid Innovation.

Brittnee MacIntyre, @BrittneeNP a nurse practitioner who recently completed graduate level training, will describe the challenges and opportunities for nurses training today, and applicability of new models of training to chronic care and the Medicare population.

Ed Salsberg,@EdwardSalsberg George Washington University School of Nursing, and founding director, National Center for Health Workforce Analysis at the Health Resources and Services Administration, will describe current and projected needs for the primary care workforce.

Deborah Trautman, (@AACNursing) chief executive officer, American Association of Colleges of Nursing, will discuss existing mechanisms for supporting the training of nursing professionals, with a focus on the role of graduate nursing education.

Moderators: 

Ed Howard (@allhealthreform), vice president of the Alliance for Health Reform

Susan Reinhard (@Susanpolicy) of AARP

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Below you will find presentations from the meeting:

Emerging Model presentation

Emerging Strategy messaging

Evaluation Update 2015

Kansas Emerging Model

BSN Foundational Courses

Direct Transfer Agreement

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Early Findings

I. RN-to-BSN Degree Awarded from a Community College

This model offers nurses an opportunity to continue their education in a community college setting and receive a baccalaureate in nursing (BSN) degree. This model is especially beneficial for nurses who are place-bound with limited access to other options in their area.

• The community college awards the BSN degree.
• Associate degree in nursing (ADN) nurses with an RN advance directly to a BSN.
• This model may be more affordable than others.
• The American Association of Colleges of Nursing (AACN) supports awarding a BSN degree at a community college provided the Baccalaureate Essentials are utilized and the program is accredited.
• This model includes an ADN followed by an RN to BSN, awarded by the community college.
• It is nationally accredited, transferrable and prepares students for graduate studies.
• This model does not include a four-year BSN offered entirely at the community college.

Advantages & strengths

• Seamless academic progression
• Higher volume: potential major BSN producer
• Offers wider geographic reach
• Moderate costs
• Diverse student bodies
• Large infrastructure
• AD nurses can work while pursuing BSN

Revisions & clarifications

• Fully accredited nationally
• Often needs state legislative approval
• Sometimes requires community college to transition to become a state college

II. State or Regionally Shared Competency or Outcomes-Based Curriculum

In this model, the partners, who generally represent different educational approaches and backgrounds, develop a shared understanding, a common goal and framework. The scope of the curriculum reaches beyond core competencies and across the entire profession, focusing on knowledge, attitudes and skills. The curriculum is not standardized, but the model aims to reach standardized outcomes.

• The partners universally agree on the outcomes.
• Agreed upon skills competencies are an example, but it is not the only example of this model.
• A substantial number of students in the state or region need to be served, including students from rural areas.
• Successful models are based on strong partnerships between community colleges and four-year schools of nursing using agreed upon outcomes or competencies to provide seamless, streamlined programs.

Advantages & strengths

• Consensus is reached by relevant Schools of Nursing on a unified set of competencies for the nurse of the future
• Needs thoughtful & inclusive definitions!
• Competencies may be incorporated into shared curriculum but shared curriculum is not required

Revisions & clarifications

• Skills competencies are an important component of this model, but do not represent the entire model
• Linking to existing competencies desirable

III. Accelerated Options: RN to MSN

This model offers a shorter timeline to completion than traditional BSN or MSN programs, providing an additional pathway to streamlined education progression. The RN-to-MSN popularity is driven by more ADN graduates returning to school with the intention of obtaining an MSN without a BSN.

• It is an accelerated model that values the practice experience of AD nurses and meets BSN criteria.
• It is a seamless, university-based program.
• It emphasizes practice components.
• A major challenge of this model is meeting the needs of students with varying clinical expertise.

Advantages & strengths

• Enables AD students to move efficiently into leadership, teaching, advanced practice & research roles
• Values the practice experience of AD nurses
• Often includes substantial online component
• Improved efficiency & flexibility for students: reduces duplication of coursework & speeds progression
• Facilitates inclusion into nursing of students with more varied backgrounds

Revisions & clarifications

• All programs must include BSN “Essentials”
  • May or may not have step out option or award baccalaureate
• Definition broadened to include other accelerated models
  • Nurses with baccalaureate in another field
  • Pre-licensure (direct entry) MSN
• Advanced degrees may offer a variety of concentrations

IV. Shared Statewide or Regional Curriculum

These educational collaboratives between universities and community colleges enable students to transition automatically and seamlessly from an AD to a BSN program, with all schools sharing curriculum, simulation facilities and faculty. Faculty workload is reduced, and the schools make greater use of resources. Its implementation requires formal articulation agreements between community colleges and universities, adjustment of prerequisite and nursing curricula, and buy-in from legislative bodies and institutions. Successful implementation of this model provides students with streamlined academic
progression. The state or regional common nursing curriculum is one example of this model.

• Examples of shared components are pre-requisites, AD portion, BSN portion and graduation requirements.
• This model includes a strong partnership between community colleges and four year schools of nursing sharing as many components as possible such as courses, requirements, enrollment and admission standards.
• A substantial number of students in the state or region need to be served, including students from rural areas.
• Although sharing all components of the nursing curriculum between community colleges and four-year schools of nursing in a state or region is an example of this model, it is not the only way to successfully implement this model.
• Successful models are seamless, student-centered and streamlined.

Advantages & strengths

• Facilitates seamless academic progression
• Creates an educational collaborative between academic institutions
• Schools may share entire or partial curriculum, as well as faculty, simulation facilities
• Reduced faculty workload: better use of resources
• Reduction in duplicative coursework for students
• Simplifies advising

Revisions & clarifications

• Can focus on pre-licensure or licensed RNs
• Needs consideration of pre-requisites, general education and graduation requirements
• Successful models are seamless, student centered and streamlined
• Sharing all components between CC & BSN programs is one example but not the only way to implement: others include standardizing AD programs only, or prerequisites

Additional Findings

Through face to face meetings and webinars, the action coalition leaders contribute to the national dialogue and understanding of education transformation by identifying the needs assessment, implementation, and evaluation strategies to successfully implement these models. The essential next steps will be identified in determining which strategy is appropriate in their state and region. The result is accelerated progress in achieving our goal to increase the number of baccalaureate prepared nurses to 80 percent by 2020.

Download the PDF

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