University of Pittsburgh School of Nursing Long-Range Plan

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University of Pittsburgh

School of Nursing

Long-Range Plan

2008-2012

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Environmental Assessment

Executive Summary

International, national, and state nursing shortages are projected to worsen over the next 10 years as increasing numbers of nurses retire. Nurses are entering the profession at an older age and plan to work fewer years in the profession than nurses have in the past. Reports estimate the national shortage of nurses will increase to more than 1 million by 2020. The nursing shortage is not unique to the United States; countries around the world are facing critical nursing shortages. There is also a shortage of faculty due to the projected retirement of current faculty and a short faculty career period, because nurses typically enter into education in their 40’s-50’s.

Pennsylvania projects changes in faculty requirements to alleviate the nursing faculty shortage. Nationally, the American Association of Colleges of Nursing (AACN) expects PhD preparation for didactic faculty and a Doctor of Nursing Practice (DNP) for clinical instruction, under supervision of PhD faculty.

Expectations for nursing education have changed in response to IOM reports on errors and safety. It is recommended that the education of health professions include: informatics, evidence based practice, interdisciplinary team practice, patient centered care, and quality improvement. Reports show patients experience lower mortality and failure to rescue rates in hospitals where more baccalaureate-prepared nurses provided direct patient care. In response, the Global Alliance on Nursing, American Organization of Nurse Executives, and AACN recommend baccalaureate (BSN) education for entry-level nurses and urge nurses with associate degrees or diplomas to pursue advanced education. The AACN introduced a new generalist master’s degree, the Clinical Nurse Leader (CNL) for direct care coordination. Due to increasing levels of responsibility of the advanced practice nurse (APN), current plans call for master’s-level APN degrees to be retired by 2015 and converted to the DNP degree, increasing educational

preparation in these programs from two years to four years.

There is a national expectation to increase the science/evidence underlying nursing practice, tempered by reductions in NIH funding and increased support for evidence based practice. The University is seeking recognition as a research intensive global institution with a highly qualified student body. Rankings are one measure of the University’s achievements.

The School increased enrollment in the traditional undergraduate program, with a 150% increase in annual new nurse graduates over the past five years. An accelerated second degree BSN program prepares more nurses for the workforce, while Fast Track Back, a continuing education program, prepares nurses returning to work. Because 80 percent of the School’s PhD graduates enter academic careers, increased resources have been directed to full time PhD study to ensure timely completion and entry into academic careers. Continuing education is emphasized for nurse educators. Funding has been secured from the state to develop a preceptor training

program that will expand clinical capacity in rural areas. Informatics instruction is incorporated at undergraduate and graduate levels and evidence based practice is a theme throughout the curriculum. The School is partnering with the School of Medicine in interdisciplinary education. The RN to MSN program has been revised. A new CNL master’s program opened in May 2005 and the new DNP program opened in January 2007, with DNP completion offered as an

alternative for master’s prepared nurses. Advance Practice Nursing programs have been

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increased from 66% to 77% (a 17% increase) over five years, and 20% of the faculty are tenured. The emphasis on research productivity and quality is reflected in the School’s rankings -

currently ranked 6th in National Institutes of Health funding, 3rd in number of NIH research grants, and 7th overall in the 2008 edition of U.S. News & World Report’s America’s Best Graduate Schools. The rankings in turn have helped attract outstanding students: the 2008 entering class has an average SAT of 1232 and 56% are in the top 10% of their graduating class. The School enrolls 1:8 or 12.5% of applicants, with approximately 50% of those admitted enrolling. We have the highest four year graduation rates in the University and this year had our first honors college graduate.

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Environment and Assessment

(In-Depth Analysis to Go Into the Overall Strategic Plans for the School)

Introduction

The oft-reported nursing shortage is only one small part of the impending healthcare crisis. There are shortages of qualified people in all the healthcare professions facing increasing demands for services from a rapidly aging population and institutions already working at or beyond capacity. With more than four times as many RNs in the United States as physicians, nurses comprise the largest single component of the healthcare workforce.

A variety of other converging social and economic forces are driving changes in the healthcare system, including an aging population of patients who are sicker and more savvy healthcare consumers, and the economics of healthcare delivery and reimbursement. At the same time, advances in scientific knowledge, new technologies, and medical discoveries have improved patient outcomes and change how healthcare is delivered.

Additional forces impacting education initiatives at the School of Nursing include: nursing faculty shortages, a series of reports and recommendations from the Institute of Medicine addressing errors and patient safety, changes in the nursing profession and recommendations to revise nursing education, state board regulations and recommendations to modify faculty requirements, NIH changes in the research infrastructure, and University efforts to earn recognition as a research intensive global institution.

Nursing Shortage

International, national, and state nursing shortages are projected to worsen over the next 10 years. According to a report released by the American Hospital Association in April 2006, U.S. Hospitals currently need approximately 118,000 nurses (RNs) to fill vacant positions nationwide. This translates to a national RN vacancy rate of 8.5%1. The nursing shortage is expected to worsen as increasing numbers of nurses retire2. In the January/February 2007 issue of Health Affairs, Dr. David I. Auerbach and colleagues estimate the U.S. shortage of RNs will increase to 340,000 by the year 20203. This number is considerably less than the number projected by the Health Resources and Services Administration (HRSA), a division of the United States

Department of Health and Human Services. In 2006, HRSA released a report projecting the national shortage of nurses will increase to more than 1 million by 2020.4 The report suggests only 64 percent of projected demand will be met, if current trends continue. And, in

Pennsylvania, a report by the Pennsylvania Center for Health Careers (PCHC) forecasts a statewide shortage of 16,100 RNs by 20105.

The shortage is compounded by constant industry growth and consistent employer vacancies, but the main problem is an inadequate number of new entries coming into the workforce to keep up with the increasing number of RNs leaving the workforce. The Pennsylvania Department of Health reports nurses are entering the profession at an older age and plan to work fewer years in the profession than nurses have in the past. According to the report, approximately twenty-one percent of nurses entering the profession in 2005 were over the age of 306. Thousands of

Pennsylvania RNs say they will leave the profession over the next ten years – the PCHC reports forty-six percent of RNs who responded to the “intent to remain in the nursing profession” question in the Pennsylvania Department of Health’s Nurse License Renewal Survey7 indicated

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their intention to leave nursing in five to ten years. Additionally, twenty-three percent of licensed RNs choose not to work in healthcare, citing unique workplace hardships (overtime, scheduling, and stress) which are directly related to the shortage, ongoing retirements, and better job

alternatives. Pennsylvania’s nursing shortage is not unique. National studies reveal almost every state is facing similar challenges.

Exacerbating the shortage is the current demographic make-up of both the state’s nursing and general populations. Beginning in 2018, it is projected there may be an insufficient number of labor force entrants in all fields to replace the baby boomers as they continue to retire. The resulting competition for workers will further impact the potential supply of RNs.

An aging workforce requires more graduates to replace retiring workers, while concurrently; an aging population requires more health care services. A significant increase in demand for health services will come as the leading edge of the baby boom generation turns 65 in 2011. And, as the baby boom generation retires, so will RNs in increased proportions. The PCHC report reveals that in 2004, approximately ninety percent of RNs in Pennsylvania were over 35 years of age, including more than forty percent over the age of 50. Nationally, RNs over the age of 50 have become the fastest growing component of the RN workforce, expanding 11 percent annually over the past four years.8

It’s not just a crisis in the United States. Countries around the world are facing critical nursing shortages. Australia, Canada, and parts of Europe and Asia also report nursing shortages. From North America to Africa and Europe, communities are challenged with growing health care needs and diminishing numbers of nurses. Sigma Theta Tau International Honor Society of Nursing calls the shortage a major threat to the future of the world’s health care system.9 Recruiting nurses from overseas is not only a shortsighted solution to the shortage; it is also a practice that is irresponsible to the global healthcare community. Bringing back nurses who are not employed in traditional settings would not solve the nursing shortage as these nurses would require re-education to function well in the current healthcare environment in the United States and would contribute to shortages in other areas.

Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis, a report released in August 2002 by the Joint Commission on Accreditation of Healthcare Organizations, illustrates how the growing shortage of nurses in America's hospitals is putting patient lives in danger.10 A study in the January 2006 issue of the Journal of Advanced Nursing, validates the findings of Dr. Linda Aiken and others that baccalaureate-prepared nurses have a positive impact on lowering patient mortality rates.11 The authors found patients experience lower mortality and failure to rescue rates in hospitals where more baccalaureate-prepared nurses provided direct patient care.

There are many explanations for hospital deaths, the most important one being how sick the patient is on admission followed by the size of the hospital, the technological capacity of the hospital, whether the hospital is a teaching facility that might bring additional resources to patient care such as resident physicians, whether the patient's attending surgeon is board

certified, and patient-to-nurse staffing ratios. After taking into account all of these other factors, the report concludes a 10% increase in the proportion of hospital staff nurses with baccalaureate degrees is associated with a 5% decline in mortality following common surgical procedures. According to the report, at least 1,700 preventable deaths could have been realized in

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nurse-to-patient ratios had been set at 1 to 4. Unfortunately, as of 2003, the American

Association of Colleges of Nursing (AACN) reports only 11% of Pennsylvania hospitals have more than 50% of the nursing staff prepared at the baccalaureate level.

The relationship between baccalaureate-preparation for nurses and lowered patient mortality rates is supported by a study published in the New England Journal of Medicine. Drs. Jack Needleman and Peter Buerhaus conclude a higher proportion of hours of nursing care provided by registered nurses (compared to licensed practical nurses and nurses’ aides) and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients.12

Nursing Faculty Shortage

But, the ability to increase the number of nurses entering the profession now and in the future is limited by a shortage of master’s and doctorally prepared nursing faculty, capacity constraints on educational institutions, insufficient clinical opportunities, and budget constraints. The AACN recognizes that the shortage of faculty in schools of nursing with baccalaureate and graduate programs is a continuing and expanding problem. In a March 2007 Fact Sheet, they report faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for nurses continues to grow.13 According to the AACN report on 2006-2007 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 42,866 qualified applicants to baccalaureate and graduate nursing programs in 2006.

According to a Special Survey on Vacant Faculty Positions released by AACN in July 200614, there is a national nurse faculty vacancy rate of 7.9%, or approximately 1.9 faculty vacancies per school, with most of the vacancies in faculty positions requiring a doctoral degree. To the casual observer, vacancy rates of less than 10 percent may not seem significant, but even one or two vacant positions in a school can have a considerable impact on the didactic and clinical teaching workload of the remaining faculty.

Although there are multiple factors contributing to the shortage of faculty, the impact of faculty age and retirement timelines coupled with an inadequate pool of younger faculty for replacement are the primary influences on future faculty availability.

Paralleling the demographic situation in the overall nursing workforce, the mean age for faculty has increased steadily. According to AACN’s report on 2006-2007 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing, the average ages of doctorally-prepared nurse faculty holding the ranks of professor, associate professor, and assistant professor were 58.6, 55.8, and 51.6 years respectively. For master’s degree-prepared nurse faculty, the average ages for professors, associate professors, and assistant professors were 56.5, 54.8, and 50.1 years respectively.15 An article published in the March/April 2002 issue of Nursing Outlook titled The Shortage of Doctorally Prepared Nursing Faculty: A Dire Situation, reports the average age of nurse faculty at retirement is 62.5 years. With the average age of doctorally-prepared faculty currently 53.5 years, a wave of retirements can be expected in the next ten years. The authors project between 200-300 doctorally-prepared faculty will be eligible for retirement each year from 2003 through 2012, and 220-280 master’s-prepared nurse faculty will be eligible for retirement between 2012 and 2018.16

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A 2005 AACN White Paper, Faculty Shortages in Baccalaureate and Graduate Nursing

Programs: Scope of the Problem and Strategies for Expanding the Supply, states, “Over the past several years, the deficit of faculty has reached critical proportions as the current faculty

workforce rapidly advances toward retirement and the pool of younger replacement faculty decreases.” 17

Efforts to expand the nurse educator population are frustrated by the fact that thousands of qualified applicants to graduate nursing programs are turned away each year – due at least in part, to a shortage in faculty. As a result, nursing education is on the verge of recursion, or infinite loop, where there aren’t enough existing faculty to train the next generation of faculty. The nursing faculty shortage is also impacted by the advanced mean age of students completing master’s and doctoral nursing degrees, which limits the number of productive teaching and research years. The AACN reports the median age of recipients of nursing doctoral degrees in 2002 was 47.3 years, with almost half of all graduates between the ages of 45 and 54 years, 12.8 percent older than 55 years, and only 8.6 percent under the age of 35.18 The decline in the number of faculty in the 36-45 age range is particularly troublesome given that the AACN has stated, “The doctoral degree should be considered the appropriate and desired credential for a career as a nurse educator.” Nationally, the AACN expects PhD preparation for didactic faculty and a DNP for clinical instruction under supervision of PhD faculty.

On the other hand, Pennsylvania is projecting changes in faculty requirements to alleviate the nursing faculty shortage. Currently, faculty must hold a master’s of science in clinical areas of instruction. Pennsylvania is considering changing that requirement to allow faculty to be

prepared with any graduate degree in nursing. Within the past year, the state directed that Nurse practitioner programs must be directed by PhD prepared faculty.

Salary is another influential factor in the nursing faculty shortage. Average salaries in clinical positions have risen more than those for faculty positions, because most universities are constrained in their ability to increase faculty salaries. As a result, academic institutions,

especially those faced with budget cuts, generally cannot compete with nonacademic employers. Master’s prepared nurses must weigh potential salaries and student loans when they consider the decision to return to doctoral study. Potential students calculate whether it profits them to seek doctoral study and enter academia when they can earn better salaries in non-academic master’s-level positions.19 According to the 2006 salary survey by the Nurse Practitioner, the average salary of a nurse practitioner was $72,480. By contrast, AACN recently reported that master’s prepared associate professors earned an average annual salary of $58,249.

Additional expectations placed on nursing faculty also influence the decision to enter academia. In addition to the many roles and responsibilities common to all faculty, nursing faculty are often expected to engage in research activities and/or maintain clinical expertise, instruct students in clinical agencies, and engage in faculty practice.20 An unpublished AACN study on employment plans found almost one quarter of all graduates from doctoral nursing programs do not plan to work in academic settings.

Nursing Education

The growing complexity of health care, expanding scientific knowledge, and increasing sophistication of technology havechanged the expectations for nursing education.

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In November 1999, the Institute of Medicine (IOM) issued the comprehensive report on medical errors, To Err is Human: Building a Safer Health System. The report, extrapolating data from two previous studies, estimates somewhere between 44,000 and 98,000 Americans die each year as a result of medical errors.21 These numbers, even at the lower levels, exceed the number of people that die from motor vehicle accidents, breast cancer or AIDs. Total national costs of preventable adverse events (medical errors resulting in injury) were estimated to be between $17 billion and $29 billion, of which health care costs represented over one-half.22 In addition,

medication-related and other errors that do not result in actual harm are not only extremely costly as well but have a significant impact on the quality of care and health care outcomes. The IOM report also focused on the fragmented nature of the health care delivery system and the context in which health care is purchased as being major contributors to the high and inexcusable error rate and compromises in patient safety.

In a follow-up report issued in 2003, Health Professions Education: A Bridge to Quality, the Institute of Medicine Committee on the Health Professions Education states, “All health professionals should be educated to deliver patient-centered care as members of an

interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.”

The Institute of Medicine (IOM) and the National Research Council of the National Academies have called for nursing education that prepares individuals for practice with interdisciplinary, information systems, quality improvement, and patient safety expertise23. In hallmark reports, the IOM focused attention on the state of health care delivery, patient safety issues, health

professions education and leadership for nursing practice. In addition, the IOM calls for dramatic restructuring of all health professionals’ education. Among the recommendations resulting from these reports are that health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality

improvement and informatics; and, that the best prepared senior level nurses should be in key leadership positions and participating in executive decisions.

While advances in scientific knowledge and new technologies have improved patient outcomes, they have also changed how healthcare is delivered. As a result, nursing today is becoming increasingly complex and challenging. Nurses need to be better educated than ever before so they are able to gather, analyze, evaluate, and apply the most current information for improved patient care and outcomes. In response to these changes and reports linking improved patient outcomes and safety to nursing education levels, the American Organization of Nurse Executives (AONE), the American Association of Colleges of Nursing (AACN), and the Global Alliance on Nursing Education have all issued statements in support of baccalaureate education.The groups concur education has a direct impact on the skills and competencies of a nurse clinician which leads to better care and improved patient safety and outcomes. And, they all conclude

baccalaureate education is necessary to prepare today’s nurses not only with a list of facts, but with the capability to evaluate and synthesize new information, the ability to adapt to an ever changing environment and the willingness to continue education as knowledge expands and delivery systems develop and evolve.

Graduate education in nursing also occurs within the context of societal demands and needs as well as the interprofessional work environment. The realities of a global society, expanding technologies, and an increasingly diverse population require nurses to master complex information, to coordinate a variety of care experiences, to use technology for health care

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delivery and evaluation of nursing outcomes, and to help clients manage an increasingly complex system of care. The extraordinary explosion of knowledge in all fields also requires an increased emphasis on lifelong learning. Nursing education must keep pace with these changes and prepare individuals to meet these challenges. Change, however cannot occur in isolation. Nursing

education must collaborate and work in tandem with the health care delivery system to design and test models for education and practice that are truly client-centered, generate quality outcomes, and are cost-effective. Significant changes must occur in both education and the practice setting to produce the delivery system desired by all constituents. New ways of educating health professionals, including inter-professional education and practice, and new practice models must be developed that better use available resources and address the health care needs of a rapidly, growing, diverse population.

In response to client care needs and to the health care delivery environment, the AACN introduced a new generalist master’s degree, the Clinical Nurse Leader (CNL) for direct care coordination. The CNL is a leader in the health care delivery system across all settings in which health care is delivered, not just the acute care setting. The implementation of the CNL role, however, will vary across settings. The CNL role is not one of administration or management. The CNL functions within a microsystem and assumes accountability for healthcare outcomes for a specific group of clients through the assimilation and application of research-based

information to design, implement, and evaluate client plans of care. The CNL is a provider and a manager of care at the point of care to individuals and cohorts. The CNL designs, implements, and evaluates client care by coordinating, delegating and supervising the care provided by the health care team, including licensed nurses, technicians, and other health professionals.

Advanced practice nurses (APNs) working in today’s healthcare environment require complex clinical skills and sophisticated knowledge of the evidence-base for practice. Currently, APNs, including Nurse Practitioners, Clinical Nurse Specialists, Nurse Mid-Wives, and Nurse

Anesthetists, are prepared in master's degree programs that often carry a credit load equivalent to doctoral degrees in some other health professions. As the knowledge requirements for practice in today's complex clinical environment steadily increased, the requirements for nursing education have also increased. 24

In a move that recognizes and validates the unique expertise of nurses engaged in clinical practice at the highest level, the American Association of Colleges of Nursing (AACN)

determined the level of preparation necessary for advanced nursing practice roles should move from the master's degree to the doctorate level. The Doctor of Nursing Practice (DNP) degree reflects the level of scientific knowledge and practice expertise required for nurses in these roles to assure high quality patient outcomes. This move is supported by a report from the National Academy of Sciences (NAS) calling for nursing to develop a “non-research clinical doctorate” to prepare expert practitioners who can also serve as clinical faculty.

Nurses graduating from this program will be prepared with a blend of clinical, organizational, economic and leadership skills. While other/existing practice disciplines focus on research, education, or practice, the DNP combines all three for advanced patient care and administrative leadership. The DNP is designed for nurses seeking a terminal degree in nursing practice, and offers an alternative to research focused doctoral (PhD) programs. The AACN intends the DNP to be the terminal degree for Clinical Nurse Specialists, Nurse Anesthetists, and Nurse

Practitioners by 2015, increasing the educational preparation in these programs from two years to four years. The CNL will be the only clinical master’s degree after that date.

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As stated earlier in this report, the AACN has determined, “The doctoral degree should be considered the appropriate and desired credential for a career as a nurse educator.”

Nursing Research

There is a national expectation to increase the science/evidence underlying nursing practice, tempered by reductions in National Institutes of Health (NIH) funding and increased support for evidence based practice. A National Academy of Sciences (NAS) report, titled Advancing the Nation’s Health Needs: NIH Research Training Programs, focuses on the career trajectory for nurse scientists and includes recommendations for responding to the shortage of nurse

investigators. The report’s recommendations to enhance the nursing research workforce, which are supported by the AACN, include creating a new institutional research training grant (T32) focused on rapid progression into nursing research careers, fast-tracking baccalaureate students into doctoral programs, and expanding the interdisciplinary scope of research-focused programs.

Evidence Based Practice (EBP)

Today’s rapidly changing healthcare environment demands that healthcare providers must constantly question if current practices are in fact best practices, and stay current with the most recent research findings to ensure patients receive the highest quality care. Research has shown clinical decisions based on best evidence, either from the research literature or clinical expertise, can improve the quality of care and the patient's quality of life.

The AACN and many other influential organizations and agencies are staunch advocates for evidence-based practice (EBP), which is supported by important landmark documents from the IOM, including Crossing the Quality Chasm (2001) and Health Professions Education: A Bridge to Quality (2003)25.

Evidence-based practice is an approach to clinical care that includes identifying specific clinical questions; collecting the best evidence; critically appraising the evidence; integrating evidence, clinical expertise, and patient preferences to implement a decision; and evaluating the outcome. EBP shifts the knowledge base of the nurse from “knowing” specific knowledge to “knowing how to access” the ever-changing information needed to manage care. Processing that

information requires nurses to expand their “critical thinking” skills to “critical synthesis” to coordinate and negotiate care across multiple levels, disciplines, and settings.

University Goals

Driven by the Board of Trustees, the University of Pittsburgh is striving to achieve recognition as an outstanding research intensive, global university with a highly qualified student body. This translates to knowledge development (research intensity), selectivity of students, and an

understanding of and participation in our profession’s relationship to the global environments. It also means our benchmarking institutions include strongly ranked public universities. And, it means our students should be prepared to be scholars and leaders in the profession. Rankings are one measure of the University’s achievements.

Response of the School of Nursing

All of these initiatives impact The School of Nursing as we examine change in our education initiatives.

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The School has increased enrollment in traditional undergraduate program with a 150% increase in annual new nurse graduates over the past five years. An accelerated second degree BSN program prepares more nurses for the workforce, while Fast Track Back, a continuing education program, prepares nurses returning to work. Because 80 percent of the School’s PhD graduates enter academic careers, increased resources have been directed to full time PhD study to ensure timely completion and entry into academic careers. Continuing education is emphasized for nurse educators. Funding has been secured from the state to develop a preceptor training

program that will expand clinical capacity in rural areas. Informatics instruction is incorporated at undergraduate and graduate levels and evidence based practice is a theme throughout the curriculum. The School is partnering with the School of Medicine in interdisciplinary education. The RN to MSN program has been revised. A new Clinical Nurse Leader (CNL) master’s

program opened in May 2005 and the new Doctor of Nursing Practice (DNP) program opened in January 2007, with DNP completion offered as an alternative for master’s prepared nurses. Advance Practice Nursing programs have been administratively structured to be led by PhD faculty. PhD prepared faculty increased from 56% to 73% (a 17% increase) over five years. The emphasis on research productivity and quality is reflected in the School’s rankings - currently ranked 5th in NIH funding and 7th overall in the 2008 edition of U.S. News & World Report’s America’s Best Graduate Schools. The rankings in turn have helped attract outstanding students: the 2008 entering class has an average SAT of 1232 and 56% are in the top 10% of their

graduating class. The School enrolls 1:8 or 12.5% of applicants, with approximately 50% of those admitted enrolling. We have the highest four year graduation rates in the University and this year had our first honors college graduate.

We have developed and instituted a curriculum which prepares both undergraduate and graduate students to evaluate and utilize evidence as a basis for practice. The impact of that curriculum is being evaluated.

Change is happening at a rapid pace and will likely continue to do so within health science and practice. We believe we are not only keeping pace, but leading the way.

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End Notes

1

American Association of Colleges of Nursing (AACN) website <http://www.aacn.nche.edu/Media/ shortageresource.htm#about>, accessed 5/18/2007: The State of America’s Hospitals

2

AACN report: Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis

3

AACN report: Better Late Than Never: Workforce Supply Implications of Late Entry into Nursing

4

The United States Department of Health and Human Services Health Resources and Services Administration, What Is Behind HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses? 2006

5the Registered Nurse Workforce in Pennsylvania: Supply/Demand Report Summer 2005 6

Pennsylvania State Health Improvement Plan, Healthy Pennsylvanians 2010 and Beyond, Special Report On The Characteristics of the Registered Nurse Population in Pennsylvania(August 2006)

7

State Health Improvement Plan: Special Report on the Characteristics of the Registered Nurse Population in Pennsylvania, Combined Data, Volume 1, Number 3, April 2004 (SHIP Report 2004)

8

Peter I. Buerhaus, PhD, RN, FAAN; David I. Auerbach, PhD; Douglas O. Staiger, PhD; Nurs Econ. 2007;25 (2);59-66. 2007 Janetti Publications, Inc.; Posted 5/17/2007; Recent Trends in the Registered Nurse Labor Market in the US: Short-Run Swings on top of Long-Term Trends.

9

Sigma Theta Tau (STT) website, accessed 6/4/07, Facts on the Nursing Shortage in North America

10

American Association of Colleges of Nursing (AACN) website, accessed 5/29/2007.

11

AACN website, accessed 5/29/2007, Impact of Hospital Nursing Care on 30-day Mortality of Acute Medical Patients

12

AACN website, accessed 5/29/2007, Nurse Staffing Levels and the Quality of Care in Hospital, New England Journal of Medicine,2002;346:1715-22.

13

AACN website, accessed 5/29/2007; Nursing Faculty Shortage Fact Sheet, <http://www.aacn.nche.edu/Media/ FactSheets/FacultyShortage.htm>

14

AACN website, accessed 5/29/2007 ibid

15

AACN website, accessed 5/29/2007, Ibid

16

AACN website, accessed 5/29/2007, Ibid

17

AACN website, accessed 5/29/2007, <http://www.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm>

18

AACN website, accessed 5/29/07, Ibid

19

AACN website, accessed 5/29/2007, Ibid

20

AACN website, accessed 5/29/2007, Ibid

21

Institute of Medicine. (1999). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press. Page 1.

22

Johnson, W.G., Brennan, T. A., Newhouse, J.P., Leape, L.L., Lawthers, A.G., Hiatt, H.H., & Weiler, P.C. (1992). The economic consequences of medical injuries. Journal of the American Medical Association267: 2487-2492.

23

Institute of Medicine reports (1999, 2001, 2003) and National Research Council of the National Academies, (2005, p. 74)

24

AACN website, accessed 5/29/2007, The Essentials of Doctoral Education for Advanced Nursing Practice

< http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf>

25

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STRATEGIC GOALS

1. FACULTY BY 2012:

a) Increase the proportion of doctorally-prepared, full-time faculty to 100%.

b) Shift the masters-prepared, full-time, non-tenure stream faculty to faculty with

doctoral preparation.

c) Increase the percentage of full-time faculty with active research programs to 75%.

d) Increase the proportion of full-time faculty with tenure to 20%.

e) Increase the diversity profile of full-time faculty to 25%.

f) Reduce the proportion of part-time faculty to 20% through full time hires.

g) Develop new partnerships with our practice partners for clinical instruction.

2. FACULTY PRACTICE

Full-time faculty in the non-tenure stream will engage in reimbursable scholarly practice activities for a minimum of 10% of their effort in collaboration with the UPMC or other sponsored projects every year for the next five years.

3. RESEARCH AND SCHOLARSHIP

a) Support and enrich the research infrastructure as needs arise.

b) Increase the professional and community visibility of the School’s research effort and

impact.

c) Emphasize cutting edge and/or high impact research activities, with a focus on

building five major areas:

Behavioral management of chronic disorders including adherence,

self-management, technology, and prevention activities

Patient management in critical care including communication, recovery, and end

of life care

Consumer informatics including education, care management, usability, and

health literacy

Genetics applications in nursing care focusing on molecular genetics and

psychosocial implications

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d) Broaden the funding base for research in light of the reduced monies in the NIH.

e) Sustain NIH rankings in the top 10 and push toward the top three.

4. EDUCATION

a) Expand the PhD and post-doctoral training capacity, emphasizing preparation for

academic/research careers.

b) Open and expand the professional Doctorate (DNP) for advanced practice nurses,

including nurse practitioners, clinical specialists, administration, and nurse anesthesia.

c) Market and expand the generalist MSN program focusing on recent graduates and

RN/BSN completion students.

d) Obtain resources necessary to sustain expansion of the Nurse Anesthesia Program.

e) Continue to recruit high quality, highly motivated, and diverse undergraduate

students with a strong interest in pursuing graduate education.

f) Expand transfer capabilities into the undergraduate program.

g) Expand scholarly international opportunities for students.

h) Explore and evaluate evolving educational technologies.

i) Offer a curriculum based on an evidence-based practice foundation at all levels of

education.

j) Establish an assessment and progression system for undergraduates.

k) Attain Commission on Collegiate Nursing Education (CCNE) reaccreditation for the

maximum time period (10 years) by successfully demonstrating continued

compliance with CCNE standards and continued advancement of the BSN, MSN and DNP programs.

l) Assess and revise the curriculum to ensure compliance with the following:

University of Pittsburgh Provost Key Attributes; American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Nursing Education, The Essentials of Master’s Education for Advanced Practice Nursing, and the Doctor of Nursing Practice Essentials; NCLEX test plan (undergraduate); Institute of Medicine (IOM) core competencies; and, CCNE accreditation standards.

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5. SERVICE

a) Expand the continuing education program for nurses, emphasizing initiatives for

nurse educators, advanced practice nurses, and administrators as well as offer preparation for return to work for RNs currently out of the field.

b) Increase community service activities through volunteer initiatives in partnership

with community need and interest both locally and state wide.

c) Expand professional leadership initiatives with professional associations, state and

federal workgroups, and related activities.

6. ADVANCEMENT AND EXTERNAL RELATIONS

a) Support the professional image of nursing and School of Nursing contributions to the

field:

Expand public awareness of the contributions of nursing to practice and science

Expand public awareness of the contributions of the School of Nursing,

specifically in education, research, leadership, and service

Expand public awareness of the evolving changes in nursing education and

practice

b) Sustain and expand targeted alumni efforts.

c) Sustain an active and involved development effort, focusing on:

increasing the numbers and sizes of scholarships

supporting research initiatives

supporting community service initiatives

supporting education initiatives

funding for endowed chairs

d) Support active recognition efforts within the school and the broader community.

7. STUDENT SERVICES

a) Support the recruitment of a diverse body of highly qualified and motivated students,

with a particular emphasis on graduate recruitment.

b) Support student advisement, registration, scholarship, and other needs of students

through direct service or referral.

c) Continue to develop, maintain, and utilize a comprehensive data base for

Figure

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References

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