Workgroup on NC Nursing Educational Program Capacity. Task Force on the NC Nursing Workforce Friday, June 20, 2003 Eastern AHEC, Greenville

(1)

Workgroup on NC Nursing

Educational Program Capacity

Task Force on the NC Nursing Task Force on the NC Nursing

Workforce Workforce

Friday, June 20, 2003 Friday, June 20, 2003 Eastern AHEC, Greenville Eastern AHEC, Greenville

(2)

Preparing for this Third Meeting

(3)

So, where are we?

?

? Several facts about NC nursing educational Several facts about NC nursing educational programs have been established and better

programs have been established and better

understood.

understood. ?

? Once understood, these facts have led to Once understood, these facts have led to the identification of a number of problems

the identification of a number of problems

or issues that need attention if NC nursing

educational programs are to be

strengthened, enlarged, or their productivity

is to be increased.

(4)

First,

?

? Some principles or planning assumptions to Some principles or planning assumptions to guide our consideration of these educational

guide our consideration of these educational

program issues. . .

(5)

Principles/Planning Assumptions

?

? RN-RN-oriented nursing education programs in NC oriented nursing education programs in NC

Community Colleges (offering the ADN) and in Community Colleges (offering the ADN) and in four

four--year colleges and universities (offering the year colleges and universities (offering the BSN) and in hospital

BSN) and in hospital--based programs are based programs are recognized as

recognized as different types of programsdifferent types of programs serving serving

different student populations

different student populations, though each may be , though each may be educating students with similar immediate career educating students with similar immediate career orientations (obtaining a license to practice as a orientations (obtaining a license to practice as a Registered Nurse).

(6)

Principles/Planning Assumptions

?

? It is important to maximize the It is important to maximize the utilization of utilization of existing resources

existing resources available for nursing available for nursing education in NC.

education in NC.

For example, high attrition rates indicate

that current faculty or facilities are not

being effectively utilized.

(7)

Principle/Planning Assumption

?

? The goal of the nursing workforce effort The goal of the nursing workforce effort should be to increase the total number of

should be to increase the total number of

licensed, practicing nurses throughout NC.

(8)

?

? In addition to the In addition to the numbersnumbers of additional of additional nurses needed, we need to give

nurses needed, we need to give

consideration to the diversity of nursing

roles

roles, and associated educational , and associated educational preparation needed for these roles.

preparation needed for these roles.

Principle/Planning Assumption

(9)

Principles/Planning Assumptions

?

? There is a need to seek an increasingly diverse There is a need to seek an increasingly diverse

array of

array of clinical teaching sites/opportunitiesclinical teaching sites/opportunities for for preparing the nursing workforce of the future. preparing the nursing workforce of the future.

?

? There is a need to creatively define and examine There is a need to creatively define and examine

how we utilize

how we utilize these clinical experiences for these clinical experiences for nursing training, including the effective use of nursing training, including the effective use of clinical teaching technologies.

(10)

Principles/Planning Assumptions

?

? It is important to incorporate the needs and It is important to incorporate the needs and perspectives of nursing

perspectives of nursing employersemployers in the in the

process of program/curriculum development

and innovation to prepare the nursing

workforce of the future.

(11)

Second,

some initial observations

Opening a can

of

(12)

Observations we have made:

?

? NC has more than 90 separate nursing NC has more than 90 separate nursing

educational programs currently in operation.

educational programs currently in operation. ?

? These programs offer nursing educational These programs offer nursing educational credentials at every level (Nurse Aide I and

credentials at every level (Nurse Aide I and

II, Diploma, ADN, BSN, MSN, PhD).

(13)

Observations we have made

?

? ADN and BSN programs are probably recruiting from ADN and BSN programs are probably recruiting from very different populations of potential nursing student

very different populations of potential nursing student

applicant pools, both for a two

applicant pools, both for a two--year nursing educational year nursing educational experience beyond the date of enrollment.

experience beyond the date of enrollment.

ADN applicants, enrolled students and graduates are

older than BSN applicants, enrolled students and

graduates.

BSN programs are usually taking students into the

program after they have completed two years of arts &

sciences curricula (at these or other institutions).

(14)

?

? There are There are “articulation” arrangements“articulation” arrangements through through

which graduates of most of these levels of nursing which graduates of most of these levels of nursing education can advance to other levels as their

education can advance to other levels as their career orientations and preferences change. career orientations and preferences change.

?

? Greater than 60% of all Registered NursesGreater than 60% of all Registered Nurses in in

North Carolina received their professional entry North Carolina received their professional entry- -level nursing education through one of the

level nursing education through one of the ADN ADN programs

programs in one of the state’s Community in one of the state’s Community Colleges.

Colleges.

Observations we have made:

(15)

Observations we have made

?

? RNRN--toto--BSN programs may be recruiting students from a BSN programs may be recruiting students from a pool of former graduates of ADN programs, who are

pool of former graduates of ADN programs, who are

themselves among the minority of total applicants to these

ADN programs by virtue of their

ADN programs by virtue of their completioncompletion of these of these programs.

(16)

?

? Community College ADN programs receive Community College ADN programs receive far more “applications” than they can admit,

far more “applications” than they can admit,

and use practically all (97%) of their

and use practically all (97%) of their “slots” “slots” approved by the NC Board of Nursing

approved by the NC Board of Nursing..

?

? BSN programs receive many fewer BSN programs receive many fewer

applications (usually after two years of

undergraduate general studies at these or

other colleges) and admit a higher

percentage of those who apply.

Observations we have made:

(17)

?

? However, BSN programs appear to be using However, BSN programs appear to be using only 74% of the

only 74% of the “slots” approved by the NC “slots” approved by the NC Board of Nursing

Board of Nursing, indicating that there may , indicating that there may be as much as 25% unused capacity in

be as much as 25% unused capacity in

these programs.

Observations we have made:

(18)

Observations we have made

?

? It appears that as many as 49% of ADNIt appears that as many as 49% of ADN students students

in Community College cohorts in Community College cohorts fail to

fail to complete these programs and graduate, complete these programs and graduate, while only 12

while only 12-25% of expected -25% of expected BSNBSN students fail students fail to

to complete their studies and receive their complete their studies and receive their degrees

degrees..

Reasons for curricular attrition in each of these programs and

interventional options need to be explored by the Task Force.

(19)

?

? For those who graduate from hospitalFor those who graduate from hospital--based based diploma programs, ADN programs or BSN

diploma programs, ADN programs or BSN

programs,

programs, pass rates for the NCLEX pass rates for the NCLEX examination

examination are high and comparable.are high and comparable.

?

? The prospects for eventual The prospects for eventual employment in employment in

nursing in North Carolina

nursing in North Carolina vary considerably vary considerably among different types of nursing educational among different types of nursing educational programs:

programs:

(ADN = 81%; BSN =74% ; Diploma = 66%). (ADN = 81%; BSN =74% ; Diploma = 66%).

Observations we have made:

(20)

Observation

?

? PNE (LPN) programs appear to be graduating only PNE (LPN) programs appear to be graduating only

49% of those they might be expected to graduate

each year.

(Note: do not have data available on applicants, (Note: do not have data available on applicants,

acceptances or enrollment in these programs at the acceptances or enrollment in these programs at the present time.)

(21)

Observation

?

? North Carolina has experienced a trend toward decreasingNorth Carolina has experienced a trend toward decreasing percentages of newly licensed and practicing RNs having

percentages of newly licensed and practicing RNs having

received their nursing education

received their nursing education in NCin NC (1995 =

(1995 = 61%;61%; 1996 = 59%; 1997 = 60%; 1998 = 58%; 1996 = 59%; 1997 = 60%; 1998 = 58%; 1999 = 56%; 2000 = 55%; 2001 =

1999 = 56%; 2000 = 55%; 2001 = 55%).55%).

Given the fact that surrounding states are expected to

experience shortages of nursing personnel

experience shortages of nursing personnel sooner sooner than NC, than NC, this reliance on nurses trained in other states may become

this reliance on nurses trained in other states may become

a serious problem for our state in the not

a serious problem for our state in the not--tootoo--distant distant future.

(22)

Observation

?

? There are areas of specialty nursing practice that are There are areas of specialty nursing practice that are

in need of additional personnel (e.g., schools, public

health, mental health, geriatrics) and these needs

should be addressed by the Task Force.

(23)

A number of developments worth

noting re. nursing education in NC:

?

? New New 22ndnd--degree BSN programsdegree BSN programs at ECU, Duke and at ECU, Duke and

UNC

UNC--CH (requiring 14CH (requiring 14-16 months of intensive study -16 months of intensive study and practicum experience)

and practicum experience)

?

? Advance placement ADN programsAdvance placement ADN programs can now be can now be

completed in 12 months (available in XX completed in 12 months (available in XX Community Colleges)

Community Colleges)

?

? New New LPN programsLPN programs beginning in 5 Community beginning in 5 Community

Colleges, bringing the total number to 34; two Colleges, bringing the total number to 34; two more programs are seeking approval (and total more programs are seeking approval (and total student population in these programs to 1,200). student population in these programs to 1,200).

(24)

Further new developments

?

? There are now 32 training programs for There are now 32 training programs for Nurse Aides in the NC Community College

Nurse Aides in the NC Community College

System.

System. ?

? These programs graduated more than These programs graduated more than 11,000 nursing assistants last year.

11,000 nursing assistants last year. ?

? AHEC and College Foundation program for AHEC and College Foundation program for stimulating interest in nursing among high

stimulating interest in nursing among high

school students

(25)

Further developments

?

? The The Nurse Education ScholarshipNurse Education Scholarship--Loan ProgramLoan Program funded by funded by the NC General Assembly in 1989 and administered

the NC General Assembly in 1989 and administered

through the NC State Education Assistance Authority

(intended to provide financial aid to students with need).

?

? The The Nurse Scholars ProgramNurse Scholars Program, also funded by the General , also funded by the General Assembly in 1989 is a merit

Assembly in 1989 is a merit--based scholarship/loan based scholarship/loan program based on superior academic and leadership

program based on superior academic and leadership

potential. Recipients enter into contract with State to

practice nursing in NC in order to cancel loan payments.

?

? Unlike the NC “Teaching Scholars” Program, these Unlike the NC “Teaching Scholars” Program, these programs may not use unused scholarship money for

programs may not use unused scholarship money for

support of extracurricular activities or “summer

experiences” to increase commitment to nursing as a

career.

(26)

White

Non

-White

Application Acceptance/Rejection Enrollment

Met admission requirements

Did not meet admission requirements Accepted Not accepted Withdrew appl. or entered elsewhere Took pre-requisites & re-applied Prerequisites not met Grades or other admission criteria not met Met admission

requirements

Did not meet admission requirements Accepted Not accepted Withdrew appl. or entered elsewhere Took pre-requisites & re-applied Prerequisites not met Grades or other admission criteria not met

Space unavailable Enrolled Enrolled Space unavailable An attempt to understand the process and outcomes of nursing education

(27)

CURRICULUM In nursing in NC In nursing outside NC Not employed in nursing In nursing in NC In nursing outside NC Not employed in nursing White Non -White

Graduation Pass Rate Employment NCLEX In nursing in NC In nursing outside NC Not employed in nursing Total % % Total %

The key question is:

Do we have enough master’s degree faculty to operate these programs?

(28)

Interest in Nursing Inquiry to BSN Program Inquiry to ADN Program Application To BSN Program Application ADN Program Prerequisites Met Prerequisites Not Met Pre-Nursing Courses

& Nurse Aide I course

Acceptance To ADN Program Complete 2-year AND Curriculum NCLEX RN Licensure Employment In or Out of Nursing Employment In or Out of Nursing Acceptance To BSN Program Completion of Jr & Sr Year Nursing Curriculum NCLEX RN Licensure Prerequisites

Not Met Pre-Nursing Courses_taken Another way to diagram the educational process:

(29)

Acceptance To ADN Program Complete 2-year AND Curriculum NCLEX RN Licensure Employment In or Out of Nursing Employment In or Out of Nursing Acceptance To BSN Program Completion of Jr & Sr Year Nursing Curriculum NCLEX RN Licensure Prerequisites

Not Met Pre-Nursing Courses_taken

Inputs

(30)

Acceptance To ADN Program Complete 2-year ADN Curriculum NCLEX RN Licensure Employment In or Out of Nursing Employment In or Out of Nursing Acceptance To BSN Program Completion of Jr & Sr Year Nursing Curriculum NCLEX RN Licensure Prerequisites

Not Met Pre-Nursing Courses_taken

Throughputs

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Complete 2-year ADN Curriculum NCLEX RN Licensure Employment In or Out of Nursing Employment In or Out of Nursing Completion of Jr & Sr Year Nursing Curriculum NCLEX RN Licensure

Outputs

ADN BSN

(32)

Preliminary Recommendation

?

? The Task Force recommends that NC DPI The Task Force recommends that NC DPI work with NC’s public and private higher

work with NC’s public and private higher

educational institutions to assure that NC

secondary schools offer and encourage

students to explore health careers and

prepare for these careers by taking

appropriate coursework options that will

assist them in meeting admission

requirements at the time of high school

graduation.

(33)

Preliminary Recommendation

?

? Programs already in place via AHEC, the Programs already in place via AHEC, the health science schools, the NC Center for

health science schools, the NC Center for

Nursing and employers (e.g., Code Blue) to

engage middle and high school students in

programs to increase interest in health

careers and prepare them for entry into

programs of higher learning need to be

strengthened and expanded.

(34)

Preliminary Recommendation

?

? NC should create incentives (e.g., additional NC should create incentives (e.g., additional

resources) to pursue national accreditation for all resources) to pursue national accreditation for all nursing education programs

nursing education programs

?

? All of NC’s nursing educational programs should be All of NC’s nursing educational programs should be

nationally accredited by the year 2015. nationally accredited by the year 2015.

Note: May want to track these changes through Note: May want to track these changes through either accreditation/licensure standards

(35)

Issues needing attention:

?

? PrePre--nursing interest stimulation nursing interest stimulation

programs

?

? ReadinessReadiness of applicants to meet of applicants to meet

prerequisites and admission

requirements

?

? Question: Are we arousing the Question: Are we arousing the

interest of the right people?

?

? Question: Are there potential Question: Are there potential

qualified individuals with nursing

interests who cannot access

these programs?

(36)

Additional issues to consider:

?

? Length of time required to Length of time required to

complete pre

complete pre--admission admission

courses and prerequisites in

Community College ADN

programs?

?

? Very little additional BONVery little additional BON-

-approved capacity for

approved capacity for

enrollment expansion in

Community College ADN

programs.

?

? What happens to the 52% What happens to the 52%

who are “accepted” in ADN

programs but who do not

enroll?

?

? What happens to the 8% of What happens to the 8% of

BSN applicants who are

“accepted” but do not enroll?

?

? It appears that there is 25% It appears that there is 25%

approved but unused

capacity in BSN programs.

Could this capacity be better

utilized?

?

? What are the alternative What are the alternative

measures of nursing

educational program capacity

other than using the BON

other than using the BON- -approved “slots.”

(37)

Additional Issues to Consider

?

? Possible rePossible re-alignment -alignment

of BON approved of BON approved “slots” with actual “slots” with actual

“enrollment” numbers “enrollment” numbers

?

? Possible proposal that Possible proposal that

BON no longer review BON no longer review and approve requests and approve requests for expansion of for expansion of enrollment in nursing enrollment in nursing educational programs educational programs ?

? StateState-supported FTE -supported FTE

student funding student funding

formulas in both public formulas in both public and private nursing

and private nursing educational programs educational programs

?

? Procedures through Procedures through

which clinical training which clinical training sites are identified and sites are identified and arranged by nursing arranged by nursing educational programs educational programs

(38)

Additional issues to consider:

?

? Are there types of nursing Are there types of nursing

education programs that are

more likely to help meet the

need for specialized nursing

personnel (e.g., school

health, mental health,

geriatrics, public health)?

(39)

Workgroup on NC Nursing Educational Program Capacity. Task Force on the NC Nursing Workforce Friday, June 20, 2003 Eastern AHEC, Greenville