Assessing Progress on the Institute of Medicine Report The Future of Nursing (2016) / Chapter Skim
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3 Achieving Higher Levels of Education
3 Achieving Higher Levels of Education
Pages 57-108
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From page 57... ...
The report suggests, however, that to work collaboratively and effectively as partners with other professionals in a complex and changing system, nurses need to achieve higher levels of education, both at the time of entry into the profession and throughout their careers. The report offers four recommendations that have implications for the education and preparation of nurses throughout their careers: • recommendation 4: Increase the proportion of nurses with a baccalaure ate degree to 80 percent by 2020; • recommendation 3: Implement nurse residency programs; • recommendation 5: Double the number of nurses with a doctorate by 2020; and • recommendation 6: Ensure that nurses engage in lifelong learning.
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From page 58... ...
And increasingly, some nurses with baccalaureate degrees in other fields begin their nursing education in so-called direct entry master's degree programs, in which the first phase of their education prepares them for the licensure examination. Regardless of the pathway taken, students must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN)
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From page 59... ...
• The Commission on Collegiate Nursing Education, working in collabora tion with the National League for Nursing Accrediting Commission, should require all nursing schools to offer defined academic pathways, beyond articulation agreements, that promote seamless access for nurses to higher levels of education. • Health care organizations should encourage nurses with associate's and diploma degrees to enter baccalaureate nursing programs within 5 years of graduation by offering tuition reimbursement, creating a culture that fosters continuing education, and providing a salary differential and promotion.
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From page 60... ...
. Baccalaureate Completion Programs at Community Colleges This model enables registered nurses (RNs)
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From page 61... ...
Shared Baccalaureate Curriculum A fifth emerging model has community colleges and colleges/universities working together to establish a baccalaureate curriculum whereby the student is able to take some classes at both the community college and the university, obtaining RN licensure only upon completion of the baccalaureate degree. Such baccalaureate completion programs may shorten the time between nurses' attain ment of associate's and baccalaureate degrees, facilitated by focused efforts such as those undertaken through APIN's shared curriculum models.
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From page 62... ...
The Campaign convened leaders in the area of academic progression in 2015 and is developing a strategy for advancing academic progression models. The impetus for these efforts is the belief that "standardizing prerequisites and general education requirements across the nation in all nursing programs is a fundamental step in advancing nursing education and removing barriers that make it difficult for nursing students to move from an associate degree in nursing to a [baccalaureate]
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From page 63... ...
These programs also may be referred to as second degree bachelor's programs. Baccalaureate completion programs are postlicensure programs that provide a pathway for individuals who already have a diploma or associate's degree in nursing and are already licensed RNs to complete their baccalaureate education in nursing.
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From page 64... ...
, August 28, 2015. FIGURE 3-2 Enrollees in baccalaureate nursing programs 2000-2014.
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From page 65... ...
Postlicensure Baccalaureate From 2010 to 2014, the number of baccalaureate completion programs increased steadily (see Figure 3-1) , and enrollment in these programs increased by 69 percent, from 77,259 to 130,345 students (see Figure 3-2)
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From page 66... ...
. In 2012, however, the number of nurses with baccalaureate degrees (including those obtained through entry-level, accelerated, and baccalaureate completion programs)
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From page 67... ...
AACN does provide a list of state loan forgiveness programs on its state policy resources page7; some of the listed programs are for practicing nurses, and many are for nurse educators and faculty. 7 See http://www.aacn.nche.edu/government-affairs/state-advocacy/resources (accessed September 15, 2015)
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From page 68... ...
At the committee's July workshop, the Accreditation Commission for Education in Nursing (ACEN) presented data showing that the mean job placement rate has decreased for nurses with associate's degrees and diplomas while remaining relatively steady for those with baccalaureate and master's degrees (Stoll, 2015)
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From page 69... ...
In 2014, 11.8 percent of hospitals said they required new hires to complete a baccalaureate within a certain amount of time, typically 2-3 years. While other studies have found that salary differentials between nurses with associate's and baccalaureate degrees are due to factors beyond just educational attainment (Duffy et al., 2014; Spetz, 2002)
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From page 70... ...
The percentage of nurses with baccalaureate degrees in office-based and ambulatory care settings fell from 9.1 percent in 2003 to 7.7 percent in 2013, while the percentage of nurses with associate's degrees in long-term care increased from 13.0 percent to 18.0 percent. Roughly 10 percent of nurses with associate's degrees "shifted from hospitals to long-term care settings over the period" (Auerbach et al., 2015, p. 10)
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From page 71... ...
. Studies show that hospitals with a higher percentage of nurses with baccalaureate degrees have better patient outcomes, and many of the outcomes associated with having a higher proportion of BSN-prepared nurses are associated with cost savings (Yakusheva et al., 2014a,b)
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From page 72... ...
If incentives for an increasingly baccalaureateprepared workforce and for baccalaureate completion -- including tuition reimbursement, pay differentials, and greater opportunities for advancement -- are offered mainly in acute care settings, nurses with associate's degrees may be channeled into other care settings, including long-term care, home health, and other community settings. Quality of New Programs Tremendous growth has been seen in the numbers of programs and enrollees in all types of nursing education programs over the last decade.
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From page 73... ...
. Minority and disadvantaged students, then, utilize associate's degree programs, baccalaureate completion programs, and community colleges to enter and advance in the field of nursing.
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From page 74... ...
Associate's degree nursing programs and community colleges generally appear to provide entry into educational pathways and careers in nursing for disadvantaged and underrepresented populations. Conclusions The committee drew the following conclusions about progress toward a higher proportion of the nursing workforce with baccalaureate degrees: Market forces are increasingly favoring baccalaureate-prepared nurses, particularly in hospital settings.
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From page 75... ...
• The Secretary of Health and Human Services should redirect all graduate medical education funding from diploma nursing programs to support the implementation of nurse residency programs in rural and critical access areas. • Health care organizations, the Health Resources and Services Admin istration and Centers for Medicare and Medicaid Services, and philan thropic organizations should fund the development and implementation of nurse residency programs across all practice settings.
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From page 76... ...
Transition-to-practice residency programs for nurse practitioners (NPs) operate in various health care settings, including retail clinics, federally qualified health centers (FQHCs)
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From page 77... ...
Currently, 21 nurse residency programs are accredited by either the American Nurses Credentialing Center (ANCC) (accredits RN residencies, RN fellowships, and APRN fellowships)
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From page 78... ...
Many of the Campaign's state Action Coalitions are working on transitionto-practice nurse residency programs. Nearly three-quarters of states responding to a 2013 survey indicated that they were working toward implementing this recommendation of The Future of Nursing, and 31 percent said it was a main
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From page 79... ...
. • The Nurse Residency Task Force in the Iowa Action Coalition has de veloped a competency-based curriculum for a nurse residency program that can be completed using online tools and learning modules (CCNA, 2014a; RWJF, 2014b)
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From page 80... ...
The length of nurse residency programs varies greatly, ranging from 6 weeks to 1 year. Because of this variation and because comprehensive data on residencies are sparse, it is difficult to gauge growth in programs overall, within particular settings, and for nurses of different educational levels since The Future of Nursing was released in 2010.
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From page 81... ...
Carolinas Healthcare System's NP postgraduate fellowship program started in October 2013 and now offers fellowships in 16 different specialties. At the committee's July 27, 2015, public workshop, Britney Broyhill, NP fellowship director in the Center for Advanced Practice at Carolinas Healthcare System, supported the inclusion of NPs in the implementation of The Future of Nursing recommendation calling for nurse residency programs (Broyhill, 2015)
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From page 82... ...
Some are open only to nurses who have completed a baccalaureate degree, while others are open to all new graduates with an RN license. The nurse residency programs on this list are offered predominantly in hospital settings.
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From page 83... ...
have both published outcome data based on 10 years of data collection (Goode et al., 2013; Ulrich et al., 2010) , and NCSBN has published findings from the implementation of its transition-topractice programs in hospital and nonhospital settings (Spector et al., 2015a,b; see also the Activity section on nurse residency programs earlier in this chapter)
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From page 84... ...
Most transition-to-practice residency programs are hospital based and focus on acute care. Finding 3-12.
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From page 85... ...
Three private philanthropic organizations -- the Jonas Center for Nursing and Veterans Healthcare, the Rita & Alex Hillman Foundation, and RWJF -- have contributed significant funds to the effort to increase doctorally prepared nurses. These organizations' programs encourage nurses to pursue a doctorate earlier in their career and place emphasis, wholly or in part, on increasing the number of nurses with research-focused PhDs in nursing.
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From page 86... ...
The Graduate Scholarships in Cancer Nursing Practice program provides a stipend of $10,000 per year for graduate students pursuing a master's degree in cancer nursing or a DNP (American Cancer Society, 2015b)
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From page 87... ...
. One Campaign state Action Coalition, Georgia, considered the doubling of doctorally prepared nurses to be its top priority (TCC Group, 2013; see Chapter 1, Figure 1-3)
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From page 88... ...
In addition, nurses with doctoral degrees in fields outside of nursing, including public policy, business, health administration, public health, and other fields, will be especially well prepared for important leadership and educational roles in an evolving health care environment. Although, as discussed above, there has been significant growth in enrollment in DNP programs in recent years, the relatively small increase in enrollment in PhD programs for nurses is concerning.
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From page 89... ...
FIGURE 3-9 Numbers of nursing PhD and DNP graduates, 2000-2014. SOURCE: Data received from AACN, August 28, 2015.
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From page 90... ...
. In August 2015, AACN acknowledged that "the national dialogue about the DNP has amplified the need to clarify" advanced nursing practice and the preparation and role of the DNP with regard to research and knowledge generation, leadership, and advanced practice (AACN, 2015c, p.
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From page 91... ...
Findings and Conclusions Findings This study yielded the following findings on doctorally prepared nurses: Finding 3-14. The recommendation of The Future of Nursing calling for a doubling of the number of nurses with a doctorate by 2020 is not specific about growth in particular types of doctoral programs (DNP, PhD in nursing, PhD in another field)
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From page 92... ...
. It suggests an emphasis on "continuing competence" rather than "continuing education" and recommends that health care organizations, schools of nursing, and accrediting institutions do their part to ensure that lifelong learning -- which "encompasses both continuing competence and advanced degrees" (IOM, 2011, p. 202)
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From page 93... ...
• All health care organizations and schools of nursing should foster a culture of lifelong learning and provide resources for interprofessional continuing competency programs. • Health care organizations and other organizations that offer continuing competency programs should regularly evaluate their programs for adapt ability, flexibility, accessibility, and impact on clinical outcomes and update the programs accordingly.
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From page 94... ...
. A 2010 IOM report, Redesigning Continuing Education in the Health Professions, states that there are "major flaws" in the way continuing education is "conducted, financed, regulated, and evaluated"; that the science behind continuing education is "fragmented and underdeveloped"; and that continuing education should bring health professionals together for interprofessional learning "with a common goal of improving patient outcomes" (IOM, 2010, pp.
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From page 95... ...
While there have been some efforts toward interprofessional learning, such as the Joint Accreditation for Interprofessional Continuing Education, continuing education has not kept pace with the needs of the increasingly complex, teambased health care system. One obstacle that stands in the way of achieving progress on the recommendation of The Future of Nursing related to lifelong learning is a lack of data on lifelong learning and continuing education for nurses.
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From page 96... ...
. AACN has said that it "would like to see more data collected about the full spectrum of educational experiences completed by RNs" and that it is "ready to work with the Health Resources and Services Administration, National Council of State Boards of Nursing, and other stakeholders to develop a plan to collect this data."20 A bullet under The Future of Nursing recommendation on lifelong learning calls for updating curricula to "ensure that graduates at all levels are prepared to meet the current and future health needs of the population" (see Box 3-6)
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From page 97... ...
RECOMMENDATIONS Recommendation 2: Continue Pathways Toward Increasing the Percent age of Nurses with a Baccalaureate Degree. The Campaign, the nursing education community, and state systems of higher education should continue efforts aimed at strengthening academic pathways for nurses toward the baccalaureate degree -- both entry-level baccalaureate and baccalaureate completion programs.
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From page 98... ...
Lifelong learning should include continuing education that will enable nurses to gain, preserve, and measure the skills needed in the variety of environments and set tings in which health care will be provided going forward, particularly community-based, outpatient, long-term care, primary care, and am bulatory settings. Nurses should work with other health care profes sionals to create opportunities for interprofessional collaboration and education.
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From page 99... ...
2015. Presentation to IOM Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health.
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From page 100... ...
Washington, DC: American As sociation of Community Colleges. http://www.aacc.nche.edu/AboutCC/whsummit/Documents/ whsummit_briefs.pdf (accessed September 18, 2015)
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From page 101... ...
2014b. NJ Action Coalition advances nurse residency program.
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From page 102... ...
2008. Standards for accreditation of post-baccalaureate nurse residency programs.
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From page 103... ...
www.joint accreditation.org/glance (accessed September 22, 2015)
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From page 104... ...
2015. Presentation to IOM Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health.
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From page 105... ...
2014b. Iowa nurses build affordable, online nurse residency program.
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From page 106... ...
2007. Nurse Residency Program executive summary.
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From page 107... ...
http://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission/Continuing Competency/FrequentlyAskedQuestionsFAQ (accessed September 22, 2015)
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