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Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing

Sabbatical Report: Statewide Nursing Articulation The Nursing Shortage & Nursing Education: Issues, Implications, Process and Transformation. Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing Fall 2007. SABBATICAL OBJECTIVES.

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Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing

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  1. Sabbatical Report: Statewide Nursing ArticulationThe Nursing Shortage & Nursing Education: Issues, Implications, Process and Transformation Deanna Suggs, RN, MSN, FNPC NMSU Carlsbad Nursing Department Director/Professor of Nursing Fall 2007

  2. SABBATICAL OBJECTIVES 1. Compare and contrast all unified statewide nursing curriculum versus basket curriculums (states to evaluate: Texas, Alabama). 2. Discuss with NMSU nursing director, Allied Health Dean, and other stakeholders the goals and conceptualization of the curriculum desired for NMSU. 3. Identify methods to facilitate articulation between the 2-year A.D.N. and 4-year B.S.N. programs within the NMSU system.

  3. SABBATICAL OBJECTIVES 4. Analyze the commonalities, key components, and difficulties associated with both forms of nursing curriculum. 5. Evaluate how funding and accreditation can be equitably addressed with each form of curriculum. 6. Identify stakeholders to be involved in a nursing curriculum transition.

  4. SABBATICAL OBJECTIVES 7. Estimate the number of students who successfully articulate with a unified form of nursing curriculum. 8. Propose a more seamless curriculum for the nursing programs of the NMSU system. 9. Possibility of submitting one journal article.

  5. SABBATICALACTIVITIES 1. Attended all NM State Board of Nursing meetings (Albuquerque, NM). 2. Completed new NMSU Carlsbad Nursing Program Handbook. 3. Assisted in paramedic meetings/class. 4. Participated in radio show promoting NMSU Carlsbad and Nursing Program with Dr. Pearson.

  6. SABBATICAL ACTIVITIES 5. Attended NLN Nurse Educator Conference and interviewed nurse leaders on articulation. 6. Attending meetings regarding clinicals in Texas. 7. Was appointed an NLN site visitor and attended training in Minneapolis.

  7. SABBATICAL ACTIVITIES 8. Wrote HED report, met with Carlsbad Foundation, and wrote a quarterly report. 9. Appointed NLAC executive commissioner. Attended training and meeting in New York. 10. Visited Alabama programs (four across the state) for one week.

  8. SABBATICAL ACTIVITIES 11. Reviewed 40 journal articles and interviewed 12+ leaders regarding articulation, and reviewed 9 nursing curriculums. 12. Participated in state nursing articulation meetings and nursing issues task force (Albuquerque, NM). 13. Met with Campus Academic Officers regarding articulation (Las Cruces, NM).

  9. SABBATICAL ACTIVITIES 14. Formulated questions for interviews regarding articulation. 15. Maintained contact with NMSU Carlsbad nursing program and NMSU regarding issues and needs. 16. Completed reference list, handouts, slide presentation, and prepared for writing an article.

  10. ISSUES: THE NURSING SHORTAGE 1. Demand exceeds supply • Average age of a practicing nurse is 45.2 years. • Baby boomers will be retiring soon; most severely hurt will be nursing education. • Increase in complexity and acuity of healthcare. • Expanding health care services and need for increased geriatric population with multiple chronic health issues.

  11. ISSUES: THE NURSING SHORTAGE 2. Poor representation of minorities and men (10% represented); lack of nurse educators with advanced degrees. 3. • 58.4% practicing RN’s has less than a BSN. • 32% have a BSN, 9.1% are MSN prepared, 0.6% have a PhD. • Salaries for nursing educators are belowpracticing RN salaries.

  12. ISSUES: THE NURSING SHORTAGE 4. Changing nature of health care has caused a lengthy educational preparation (A.D.N. average is 3 years). 5. Increased complexity with concerns of quality patient care are indicative of need for better educated workforce. • Adequacy of nursing services is greatest threat to the future of quality health care.

  13. ISSUES: THE NURSING SHORTAGE • Shortage of nurses results in closing hospital units, nursing home beds, etc. • Push towards accountability and competencies.

  14. ISSUES: THE NURSING SHORTAGE 6. Qualified nursing applicants are turned away citing limited classrooms, clinical sites, educators, and infrastructure despite increasing enrollment numbers to a crumbling system.

  15. ISSUES: THE NURSING SHORTAGE 7.Need for cost efficiency, redesign care delivery system/satisfaction, competency base, differentiation of practice and increase funding/resources. 8. Segregated system-healthy private/public partnerships. 9. Perceived lack of transferability/mobility in nursing programs. 10. Lack of communication and networking of health professionals/educators.

  16. How does NM compare in the nursing shortage and issues? • Average facility RN vacancy rate 30.6 • Average LPN facility vacancy rate 0-50% • Majority of facilities do not differentiate pay for BSN • 68.4% of health facilities indicated nursing staffing had impacted access to care

  17. How does NM compare in the nursing shortage and issues? • Average RN (ADN or BSN) salary: $58,856 (RN) and $41,427 (LPN) ■ Average MSN-ADN educators range from $38,633 - $50,000. Community RN pay is $71,500. 33% work 2nd job. ■ Average MSN/PhD-BSN or higher educators salary average $76,400. None work 2nd job.

  18. How does NM compare in the nursing shortage and issues? • Barriers to increasing enrollment cite lacking infrastructure - No permanent funding - Poor recruitment and retention - Limited clinical sites - Poor or lacking facilities (clinical, classroom, lab)

  19. How does NM compare in the nursing shortage and issues? • NM is experiencing a more severe nursing shortage than the rest of the nation - Insufficient RN’s to meet demand - Many RN’s will be retiring and this trend will continue through 2020 - Many RN’s in NM are 50 years old and older

  20. How does NM compare in the nursing shortage and issues? • Funding for nursing training is inadequate to meet the expected sharp increase in demand • Down 35% (1973-1990) in young females choosing nursing • NM average RN vacancy rate is projected at 10-24%

  21. What has NM done to address the nursing shortage? • 1999 NM Consortium for Nursing Workforce Development developed standards for differentiated practice comparisons. • 2002 NM Nursing Shortage Statewide Strategy framework

  22. What has NM done to address the nursing shortage? PRIORITIES: 1. Double number of licensed nursing graduates in NM - Nursing faculty shortage - Improve clinical site rotations - Expand enrollment in nursing programs

  23. What has NM done to address the nursing shortage? - Accelerate programs at attract students - Seamless curriculum articulation - Direct support to students • Clinical teaching at institute • Reduction in student attrition

  24. What has NM done to address the nursing shortage? 2. Sustain this effort over the long term - Leadership - System wide communication - Data collection, analysis, forecasting - Goals of private/public partnerships - Statewide organization and infrastructure • Center of Nursing Excellence • Strategies

  25. Center of Nursing Excellence Most recent reports: • Vacancy and turnover in NM hospitals: Report of Survey (June 2007) • Report of NM Education Survey (August 2007) • Status of Nurses in NM (December 2007)

  26. Legislative Support • Nonpermanent funding through HED for program improvement • Focus continues to be on enrollment numbers despite noted barriers noted previously • Nonpermanent nursing educator incentives • Scholarship funds for students

  27. Nursing Articulation Task Force • NM competencies • Vision/Barriers/Meetings • Nursing transfer module • Nursing matrix • “NM Schools of Nursing Articulation Plan” • Working with SBON and NM Center of Nursing Excellence

  28. Do we have a seamless nursing curriculum? • History of articulation (national) • ANA position statement supporting competencies • Writers for 1st position paper on nursing education for nurses envisioned an orderly transition into nursing at two levels: 1) Professional 2) Technical

  29. Do we have a seamless nursing curriculum? • 1965 ANA Barbara Scott “Nurses are wasting their time and energy debating over collegial education of tomorrow’s nurse.” • 1966 ADN programs growth explosion with nursing shortage (940 ADN programs today; 600 in community colleges)

  30. Do we have a seamless nursing curriculum? • Secretary’s Commission on Nursing 1988 identified second shortage on demand side - Lack of interest in nursing too demanding too undervalued unrewarding pay

  31. Basically issues of autonomy and financial culture of nursing education, the nature of nursing practice, and nursing supply 35 years after position statements note similarities between 1965 – 2000+

  32. Failure to resolve workplace issues • Efforts to describe, quantify and address workforce issues & relationships to health care outcomes complex • Nurses lack satisfaction in their work • Unlicensed professionals included to meet needs • Nursing feelings of powerlessness, alienation

  33. Types of Articulation Mandated (8 states) – formal agreements exist as part of legislation & mandate credit transfer between nursing programs Statewide Articulation Agreements (24 states) – voluntary articulation plans and models are developed through the collaborative efforts of nursing education, regulations, legislators, and other stakeholders.

  34. Types of Articulation Individual School to School Articulation Agreements (18 states) – Individual agreements between ADN/BSN programs delineating which nursing courses will transfer and maximum nursing credits accepted. No blanket agreements exist.

  35. Within the NM region: Statewide – Arizona Colorado (forerunners) Mandated - Texas (basket curriculum numbering) Individual - NM

  36. Avenues to Licensure • Diploma • ADN • BSN • Some MSN Deeply imbedding in articulation is: - common competencies - differentiation of practice

  37. Pro’s of Articulation • Clear expectations to students • No repeated material • Individual accreditation • Financial strength from collaboration

  38. Pro’s of Articulation • Students don’t repeat same courses when transferring, decreases time to reenter programs • Social justice for student (average 3 years to complete ADN) • Seamless system • Affordable

  39. Pro’s of Articulation • Equitable • Identifies changing student needs • Increase faculty sharing • Shows public/legislative coordination, sharing of resources & collaboration

  40. Pro’s of Articulation • Increases quality/assists new educators through increased communication/sharing • Can increase funding opportunities (state/federal) • Can start regional/system wide then progress. • Can use zip code for school tracking/data collection.

  41. Pro’s of Articulation • Each program can have own philosophy, concepts, delivery methods & class point assignments (academic freedom) “Above or below the line.” • Ease of ADN into BSN programs • Common trust & integrity fastened with all programs. Can assist weaker programs.

  42. Pro’s of Articulation • Can provide multiple entry/exit • Common competencies foster accountability, facilitate student expectations, promote quality of care • Opportunity to increase distance learning • Opportunity for high school dual enrollment (faculty career clusters)

  43. Con’s of Articulation • Labor/time intensive • Requires commitment & multiple input • Average time is 2 years – 4 years to progress and 2 years to phase out old curriculum ■ Money & infrastructure must be strengthened

  44. Con’s of Articulation • Continually needs collaboration, refinement, and support • Is not indicative of increasing number of enrollment or completion • Does not necessarily change barriers (i.e. clinical sites) to enrollment

  45. Con’s of Articulation • Does not indicate increase in students transferring between programs • Unknown effect on quality programs (?) • Can limit innovation in curriculum to course progression • Average or slightly decreased pass rates have been noted

  46. Requirements for Articulation • Infrastructure ■ Commitment • Funding ■ Partnerships • Communication ■ Faculty developed/ owned • Collaboration ■ Trust/collegial respect

  47. Recommendations • Strengthen partnerships between academic, service, government • Support new graduates • Common competencies/model – ID for continuing practice • Increase collaboration between program types

  48. Recommendations • Implement recruitment activities at local levels emphasizing adult, minorities, men, young students • Efforts showed focus on communities we serve • Reallocate funds, reprioritize services, share resources, increase educational efficiencies

  49. Recommendations • Define articulation, competencies & practice in NM • Include workforce issues recognition • Multiple stakeholders • Valuing nursing & contributions

  50. Recommendations • Outcomes, data analysis, strategic planning • Evaluate needs & goals • Focus on long range effects • Multiple entry/exits to increase workforce numbers

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