Nursing Programs and Funding Reviewed

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2 Table of Contents Executive Summary... 1 A Critical Shortage of Nurses... 4 Long Waiting Lists: A Lack of Program Capacity... 4 Barriers to Increasing Program Capacity... 5 A Charge from the Kansas Legislature... 6 Response from the Kansas Board of Regents... 6 Recommendations from the Kansas Board Of Regents... 7 A Legislative Appropriation... 8 Implementation of the Nursing Initiative... 8 Current Shortage of Nurses... 9 Nurse Educator Service Scholarship Program Nurse Educator Service Scholarships Awarded AY AY2012 Summary of Nurse Educator Service Scholarships Nursing Faculty Salaries and Supplies Grant Program Nursing Faculty Salaries and Supplies Grant Program Data FY 2007-FY 2013 Summary of Nursing Faculty Salaries and Supplies Grant Nursing Supplies Nursing Equipment and Facility Upgrades Grant Program Nursing Equipment and Facilities Upgrades Grant Program Data as of June 30, 2007 Summary of Nursing Equipment and Facilities Upgrades Grant Program for FY 2007 Building Nursing Education Simulation Capacity in Kansas Increased Enrollment in Nursing Education Programs Nursing Student Admissions and Graduates Compared to Baseline Year Looking Toward the Future... 19

3 Appendices Appendix I - Nursing Grants Review Committee Appendix II - Nursing Initiative Report Acronyms Appendix III - Kansas RN Program Patient Simulator Lab Locations ACKNOWLEDGEMENTS Editors: Lisa Beck and Steve Larrick - Kansas Board of Regents Reviewed by: Carol Moreland, MSN, RN, Education Specialist and Mary Blubaugh, MSN, RN, Executive Administrator - Kansas State Board of Nursing Designer: Pam Greene - Kansas Board of Regents

4 THE KANSAS NURSING INITIATIVE EXECUTIVE SUMMARY Genesis of the Nursing Initiative In 2004, the U.S. Department of Labor identified Registered Nursing (RN) as one of the top occupations in terms of job growth through the year The Kansas Occupational Outlook, published by the Kansas Department of Labor in 2005, identified RNs experiencing a projected growth of 31.2 percent, or 6,890 additional RN positions needed by At a September 2005 conference in Topeka, nursing program directors from across the state identified four major barriers that limited increased enrollment and subsequent graduation of more registered nursing students. These barriers were: (1) an insufficient number of qualified nursing faculty, (2) competition among programs for clinical placement sites, (3) classroom and laboratory space constraints, and (4) additional equipment needs. In January 2006, The Kansas Board of Regents (KBOR) submitted a report to the Governor and the Legislature describing the resources required to increase the capacity of the state higher education system to accommodate up to 250 more nursing students annually. In spring 2006, the Legislature responded to the report by investing $3.4 million dollars in grant funds to begin addressing each of the four barriers to nursing education program expansion. The Legislature authorized KBOR to distribute these funds annually in three specific areas based on the key barriers identified in the report. FY 2007 Kansas Nursing Initiative Award: Nurse Educator Service Scholarships: $200,000 with a required match of $1 per $2 awarded Nursing Faculty Salaries and Supplies: $1,200,000 with a required match of $1 per $1 awarded * Nursing Equipment /Facility Upgrades: $2,000,000 with a required match of $1 per $2 awarded ** * For FY 2008, the Kansas Legislature increased the grant appropriation for Nursing Faculty Salaries and Supplies by $600,000 for a new annual total of $1,800,000. Each institution submitted a supplemental grant proposal for a portion of these additional funds. For FY 2009, the Kansas Legislature again increased the grant appropriation for Nursing Faculty Salaries and Supplies by $100,000 to be awarded to private nursing programs, for a new annual total of $1,900,000. ** This particular grant appropriation was established for one year only, and was terminated at the end of FY In response to the legislative appropriation, in June 2006, KBOR staff created and released a Nurse Educator Service Scholarship announcement, a Nursing Faculty Salaries and Supplies request for proposals, and a Nursing Equipment and Facility Upgrades request for proposals. Snapshot of Success Nursing Initiative Achievements (FY 2007 through FY 2013): 1) 3,056 Additional nursing students admitted (175% above goal) 2) 263 Additional full-time and 277 additional part-time nursing faculty hired 3) 167 Nurse Educator Service Scholarships awarded 4) 27 Human patient simulators placed into nursing classrooms 5) 1,873 Additional nursing students graduated 1

5 Thirteen of the 16 public two-year institutions offering an Associate Degree in Nursing (ADN) are participating in the initiative. All six public institutions offering a Bachelor of Science Degree in Nursing (BSN) and all five public institutions offering a Master of Science Degree in Nursing (MSN) are participating in the initiative. The Nurse Educator Service Scholarship Program The objective of the Nurse Educator Service Scholarship program was to increase the number of qualified nursing faculty in Kansas postsecondary nursing education programs. Scholarships were awarded to applicants who agreed to engage in the full-time (or the equivalent to full-time) teaching of nursing in a Kansas nursing program after receiving their master or doctorate degree in nursing. This investment required a $1 match for every $2 of state funding, subject to annual appropriation from the Kansas legislature. An annual total of $300,000 was available ($200,000 grant funding plus $100,000 required match) for distribution to the five eligible institutions that provided Master of Nursing or Doctorate in Nursing degree programs. Institutions indicated the number of service scholarships requested and agreed to all conditions in the scholarship announcement. The Nurse Educator Scholarship Program, after seven years, has proven to be a wise investment for the state. As of June 30, 2013, $835,822 in scholarship funds were awarded, including 167 service scholarships; 62 individuals have graduated and are employed as nurse educators in Kansas. The scholarship incentive has complemented the Nursing Faculty Salaries and Supplies Grant by increasing the availability of qualified nursing faculty and continuing to support program expansion. The Nursing Faculty Salaries and Supplies Grant The Nursing Faculty Salaries and Supplies Grant provided funds to increase the number and retention rate of qualified nursing faculty and purchase the consumable supplies needed for laboratory and classroom instruction in nursing programs. This investment required a dollarfor-dollar match and was subject to annual appropriation from the Kansas Legislature. Initially, this grant made available a total of $2.4 million ($1.2 million grant funds plus $1.2 million in required matching funds) to hire additional nursing faculty and secure additional instructional supplies. All 22 publicly-funded educational institutions in the state with approved RN programs were encouraged to apply. In FY 2007, sixteen publicly-funded institutions submitted applications and were awarded funding. In FY 2008, the Kansas Legislature appropriated an additional $600,000, thus increasing the grant amount from $1.2 million to $1.8 million annually ($3.6 million total with required match). Each institution was invited to submit a supplemental grant proposal for this additional grant funding. Three additional publicly-funded institutions submitted applications and were awarded funding, raising the total number of publicly-funded institution grant participants to nineteen. In FY 2009, the Kansas Legislature appropriated an additional $100,000 for nursing faculty salaries and supplies, intended for private nursing programs, thus increasing the grant amount to $1.9 million annually ($3.8 million total with required match). Each private institution with a nursing program was invited to submit a grant proposal for this additional grant funding. Four nursing programs at private colleges submitted proposals and were subsequently approved for funding. Three of these institutions remain as participants in the initiative. 2

6 As of June 30, 2013, a total of $24,828,800 (grant with required match) was expended for additional faculty and $890,676 (grant with required match) was expended on classroom supplies. The Nursing Equipment and Facility Upgrades Grant The Nursing Equipment and Facility Upgrades Grant offered the opportunity for assistance in obtaining new technology and equipment for the institution s nursing programs (such as patient simulators) and/or increasing physical space, both classroom and laboratory, to accommodate an increase in nursing student capacity. All 22 publicly-funded educational institutions in the state, with approved RN programs, were encouraged to apply for this grant. The grant, with a required 1:2 match, made available a total of $3 million ($2 million grant funds plus $1 million in required match). Each of the 18 institutions applying for this grant requested funding for additional equipment; eight institutions also requested funding for modifications to their facilities. For FY 2007, institutions reported total expenditures for equipment (grant with required match) of $2,674,548 and total expenditures for facilities modifications (grant with required match) of $622,247, for a grand total of $3,296,795 expended as a result of this grant. Eight institutions increased their required match, primarily for additional equipment, which increased the total grant expenditures by $296,795. With the challenges of placing more students into a finite number of clinical learning sites and the desire to give students more opportunities to practice specific skills and make critical patient care decisions in a safe and controlled environment, the focus of this grant was to place additional human patient simulators in nursing programs throughout the state. As a direct result of this funding initiative, statewide simulation activity increased dramatically in Because of this grant, institutions were able to purchase 27 human patient simulators and related ancillary equipment. Since that time, institutions have used other sources of funds to purchase additional human patient simulators and simulation training has become a best practice model in nursing education. Increased Enrollment in Kansas Nursing Education Program The primary goal of the Kansas Nursing Initiative is to increase enrollment in and graduation from RN education programs, thus helping alleviate the state nursing shortage. Increased student enrollment has positively impacted the waiting lists of qualified students seeking admission into these programs. Additionally, several nursing programs placed added resources toward reducing student attrition. Based on data provided by the Kansas Board of Nursing (KSBN Annual Reports), these funded programs have admitted an average of 437 additional nursing students annually, totaling 3,056 over a seven year period, and have exceeded the initiative goal of increasing enrollment annually by 250 students. The full impact of this initiative began to manifest in FY 2009, when the first cohort of additional students graduated and entered the workforce. Since inception of this initiative (FY ), an additional 1,873 nursing students have graduated from Kansas nursing education programs. 3

7 The Kansas Nursing Initiative An Investment in the Value of Nursing A CRITICAL SHORTAGE OF NURSES Hutchinson Community States have historically been the guardians of public health and, as such, they constantly search for new strategies to enhance healthcare access and quality for their citizens. A major impediment to the delivery of quality healthcare is a growing shortage of healthcare providers, with the largest shortage in the area of nursing. In 2002, The American Hospital Association Commission on Workforce for Hospitals and Health Systems stated, Among the many issues facing the field of healthcare, none is more important to its long-term future than solving the growing workforce crisis. Hospitals and other facilities that provide patient care were threatened by a chronic shortage of nurses. Multiple reasons explained the nursing shortage, including: An aging population that required increased utilization of the healthcare system; An increase in the number of nurse and other healthcare professional retirements; Fewer potential workers to replace those who were retiring; and Increased attrition of existing healthcare professionals, due to an increased workload and faster pace, resulting in discontented caregivers providing less bedside time. The implications were that an aging population would place greater demands on the healthcare system while, at the same time, many healthcare professionals would be retiring. In 2004, the U.S. Department of Labor identified Registered Nursing as one of the top occupations in terms of job growth through the year According to a U.S. Department of Health and Human Services study, by 2010 the shortage of qualified healthcare workers was expected to reach 12 percent nationally, and grow to 29 percent by This translated to a need for 1,101,000 additional registered nurses nationally to meet the demand by the year The outlook in Kansas was similar to the national trend. The Kansas Occupational Outlook, published by the Kansas Department of Labor in 2005, identified the top ten occupations for projected growth through Registered Nurse was listed second, with a projected growth of 31.2%, or 6,890 more RNs needed by Coupled with 4,460 RN replacements, due to retirements in the same time period, the total projected need for RNs was expected to exceed 11,350 by The need for additional Licensed Practical Nurses (LPN) for this time period was projected to be 3,370 (a number that does not include replacement positions needed due to retirements). LONG WAITING LISTS: A LACK OF PROGRAM CAPACITY As a result of intensive ongoing efforts to encourage students to pursue careers in healthcare, the issue of educational program capacity and growth became paramount. Admission data provided by the Kansas Board of Nursing (KSBN) for 2005 indicated that almost all nursing programs had full admissions and some programs reported waiting lists of qualified students. Applicant data was also obtained from the Kansas State Nurses 4

8 Association (KSNA) study, Nursing Shortage: Environmental Assessment of Nursing Education and Faculty in Kansas, published in August 2005 and revised in November The KSBN and KSNA data, which included information from both public and private nursing programs, demonstrated more qualified applicants than program capacity. Data reported by institutions responding to a community college nursing survey conducted by the Kansas Association of Community Trustees (KACCT) in 2005, also indicated that the number of qualified applications consistently exceeded the current admission capabilities of nursing programs at Kansas community colleges. Finally, in a Kansas Board of Regents (KBOR) survey of academic deans of institutions with nursing programs conducted in 2006, the vast majority stated that they could not accommodate more nursing students unless more qualified nursing faculty were available, facilities were expanded, and the issue of clinical access was addressed. BARRIERS TO INCREASING PROGRAM CAPACITY On September 15, 2005, a conference was held in Topeka for nursing and allied health educational program directors. Ninety nursing and allied health program directors representing one-, two-, and four-year programs from across the state, were asked to identify barriers that currently prevented them from admitting additional students into their respective educational programs. From their responses the primary barriers included: (1) an insufficient number of available qualified faculty, (2) competition among programs for clinical placement sites, (3) classroom and laboratory space constraints, and (4) additional equipment needs. Barrier I: An Insufficient Number of Qualified Faculty In 2005, the National League for Nursing estimated 92,000 qualified applicants were not admitted to entry-level nursing programs due, primarily, to a shortage of qualified faculty. In 2006, nearly 63 percent of full-time faculty members at the nation s nursing schools were between the ages of 45 and 60; 9 percent were over the age of 61. In Kansas, KSNA surveyed Colby Community deans and directors of nursing programs to project retirements based on their knowledge of individual faculty. The results indicated that the median age of nursing faculty in Kansas was between years, with a projected retirement of 32 MSN and/or PhD- prepared nursing faculty by Additionally, 123 MSN and/or PhD- prepared nursing faculty indicated that they plan to retire by In addition, disparity between salaries of nurse educators and advanced practice nurses contributed to the shortage of qualified nursing faculty. Results of the same KSNA study showed that salaries of mastersprepared faculty, with a nine month contract pro-rated to twelve months, fell within a range of $44,947 to $60,000, which was well below the average masters-prepared nurse salary of $70,642 in Kansas (American Academy of Nurse Practitioners, 2004). According to the study, the length of time required to obtain the degrees required for full-time faculty, combined with a significant salary disparity between education and practice, created a disincentive for many nurses to enter teaching. The Kansas Department of Labor Kansas Wage Survey 2011 placed the average wage in Kansas of an MSN Nurse Educator at $57,130 and an Advanced Practice Registered Nurse (APRN) at $82,100. These are mean statewide wages, which do not reflect geographic regions, rank or other differentials. The large gap in wages between a postsecondary Nurse 5

9 Educator and an APRN working in the field makes it difficult for qualified individuals to choose the Nurse Educator option. Barrier II: Clinical Access Many nursing programs have not been able to accommodate more students due to competition for specific clinical education sites. Competition also exists among nursing and allied health education programs for access to established clinical sites. Additionally, students in nursing programs located in several rural areas of the state are required to drive significant distances, sometimes out-of-state, to obtain their required clinical training. Program directors indicated human patient simulators could be a tool to reduce the time demand on clinical sites by better preparing students in specific techniques before these students entered clinical training. The simulators would also expose students to a wider scope of patient conditions than they might encounter during their clinical education. Barrier III: Limited Classroom, Laboratory, and Equipment Availability Nursing and allied health program directors also voiced concerns regarding the lack of adequate physical space, both classroom and laboratory, as a barrier to increasing student capacity. Insufficient space crowds students and results in an inadequate learning environment. Many program directors indicated another primary deterrent to increasing student enrollment was a lack of sufficient technologically advanced equipment and the increased stress placed on existing equipment. A CHARGE FROM THE KANSAS LEGISLATURE The Legislative Budget Committee expressed concern over the shortage of nurses in Kansas and recognized that the problem would only worsen as the current workforce neared retirement. The Committee requested that the Board of Regents submit a report to the Governor and the 2006 Legislature addressing the resources needed to increase the capacity for educating registered nurses in the state higher education system by 250 students annually. RESPONSE FROM THE KANSAS BOARD OF REGENTS In developing a plan to increase the capacity of state nursing programs, KBOR focused on the following methodologies: Review the number of nursing program admissions and graduates over the past several years and compare that data with the Department of Labor projected need for additional nurses. Calculate the number of additional nursing program graduates needed annually to meet the Department of Labor projections over a ten year period. Review the research and data from the KBOR, KSNA, and KSBN on barriers to increase the capacity of state nursing programs. Survey academic deans of institutions with nursing programs to identify the resources and associated costs needed to increase program capacity by 250 students annually. Establish a collaborative partnership among organizations with a vested interest in nursing education and workforce issues. These partners offer comments and suggestions, serve as information resources, help assure reporting accuracy, and assist with evaluations of grant funding proposals from educational institutions. These 6

10 partners include KSBN, KSNA, Kansas Hospital Association (KHA), Leading Age Kansas (previously known as: Kansas Association of Homes and Services for the Aging - KAHSA), Kansas Health Care Association (KHCA), and Kansas Organization of Nurse Leaders (KONL). Convene a meeting of nursing program directors from state universities and Washburn University, to discuss future nursing faculty preparation. Develop an implementation timeline to assist nursing programs with additional resources, provide staff development, hire additional qualified nursing faculty, and implement facility modifications where necessary. RECOMMENDATIONS FROM THE KANSAS BOARD OF REGENTS Providing nursing education programs the capability to accommodate more students, while specifically admitting and graduating up to 250 additional RN students annually, required an array of strategies to address multiple barriers. Based on methodologies previously outlined, focused meetings with directors from one-, two-, and four-year nursing programs, and input from representatives from KHA, KSBN, and KSNA, the following key areas were recommended as solutions in A Report Addressing the Resources Needed to Increase the Capacity of the Kansas Board of Regents System for Educating Registered Nurses. Recommendations to Address Barrier I: (Faculty) A. Develop a targeted service scholarship program that provides tuition forgiveness as an incentive. The objective was to encourage current BSN- prepared nurses to obtain an MSN degree and become a nurse educator. As a condition of participation in this program, service scholarships recipients agree to become nurse educators in Kansas postsecondary institutions for a specified period of time after obtaining their MSN degree. Projected costs of this service scholarship program were $200,000 per year for a ten- year period. B. Provide funding to hire additional nursing faculty. Based on the survey KBOR conducted of academic deans of institutions with nursing programs, an additional 31 nursing faculty were required, with a projected initial investment of $1,500,000 per year. KBOR and the academic deans also recognized that salary disparities between clinical practice and education had an impact on faculty recruitment. Recommendations to Address Barriers II and III: (Access, Space and Equipment) A. Provide funding to assist with obtaining additional equipment and supplies needed to accommodate an annual increase of at least 250 additional nursing students. Because of the limited availability of clinical education sites and competition among healthcare programs for existing sites, nursing programs were encouraged to increase the utilization of human patient simulators and establish simulation laboratories. Clinical simulation laboratories effectively extend and enhance student clinical education experience, thus reducing the burden on clinical sites. Projected costs for human patient simulators and additional equipment and supplies were $3,087,260. B. Provide funding to assist with facility enhancements to accommodate additional nursing students. Several state nursing programs needed some facility renovations to accommodate an increase in student enrollment. Also, the increased use of simulators requires the creation of additional simulation laboratories. Projected costs for facility renovations were $750,000. KBOR submitted this report to the Governor and the Legislature in January

11 A LEGISLATIVE APPROPRIATION The Legislature responded to the KBOR report by investing $3.4 million dollars in grant funds to begin addressing barriers to program expansion and increasing the capacity of the state s registered nursing programs. The Legislature authorized KBOR to distribute these funds in three specific areas based on the key barriers identified in the report. Nurse Educator Service Scholarships: $200,000 with a required match of $1 per $2 awarded Nursing Faculty Salaries and Supplies: $1,200,000 with a required match of $1 per $1 awarded * Nursing Equipment/Facility Upgrades: $2,000,000 with a required match of $1 per $2 awarded ** * For FY 2008, the Kansas Legislature increased the grant appropriation for Nursing Faculty Salaries and Supplies by $600,000 for a new total of $1,800,000. Each institution submitted a supplemental grant proposal for a portion of these additional funds. ** This particular grant appropriation was established for one year only, and was terminated at the end of FY IMPLEMENTATION OF THE NURSING INITIATIVE In response to the legislative appropriation, KBOR created and released a Nurse Educator Service Scholarship announcement, a Nursing Faculty Salaries and Supplies request for proposals, and a Nursing Equipment and Facility Upgrades request for proposals in June The expected outcomes of the Nursing Initiative were: (1) Achieve an overall increase of 250 students annually in the number of qualified nursing students admitted to registered nurse educational programs in Kansas; (2) Increase the number of nursing students graduating and passing the National Council Licensure Examination (NCLEX); and (3) Increase the number of graduates working in the field of nursing in Kansas. KBOR sent the Nurse Educator Service Scholarship announcement to all five publicly-funded postsecondary educational institutions in Kansas engaged in providing a Masters or Doctorate in Nursing degree. These institutions included: Fort Hays State University, Pittsburg State University, The University of Kansas Medical Center, Washburn University, and Wichita State University. Funding proposals received in July 2006 indicated the number of scholarships requested and included an agreement to all conditions outlined in the announcement. A Nursing Initiative Grant Review Committee (See Appendix I), comprised of representatives from KONL, KHCA, KSNA, KHA, LeadingAge Kansas, and KSBN, formed to review the proposals submitted for the Nursing Faculty Salaries and Supplies grant and the Nursing Equipment and Facility Upgrade grant. This committee made funding recommendations to KBOR staff, which subsequently determined final allocations. Notification of the funding awards was sent to all participating institutions on July 19, This committee also reviewed supplemental proposals submitted for the additional $600,000 funding allocated by the Legislature for the FY2008 Faculty Salary and Supplies Grant. Notification of these supplemental funding awards was sent to participating institutions on July 20,

12 CURRENT SHORTAGE OF NURSES In January 2006, The Kansas Board of Regents (KBOR) submitted a report to the Governor and the Legislature describing the resources required to increase the capacity of the state higher education system to accommodate up to 250 more nursing students annually. In spring 2006, the Legislature responded to the report by investing $3.4 million dollars in grant funds to begin addressing each of the four barriers to nursing education program expansion. The Legislature authorized KBOR to distribute these funds annually in three specific areas based on the key barriers identified in the report. Since that time, the Kansas Nursing Initiative has allowed nursing programs to accommodate 3,056 additional nursing students from its inception in FY 2007 through FY 2013, thus significantly reducing or eliminating waiting lists at the participating institutions. The economic downturn has also impacted nursing program admissions. RNs delayed retirement, due to financial constraints, causing a reduction in healthcare workforce turnover and reduced nursing vacancies in many hospitals. However, as the economy recovers, healthcare workforce growth is projected to increase and RNs who delayed retirement will begin to exit the workforce. With the demands of an aging baby boomer generation and the requirements of the Patient Protection Affordable Care Act, the need for healthcare services and the demand for nurses is anticipated to increase. This increase in demand will impact nursing program applications as more individuals choose to pursue employment due to the growing job market. This cycle is projected to again result in more qualified applicants than program capacity at many educational institutions. According to a 2012 Bureau of Labor Statistics report, the health care and social assistance sector is projected to gain the most jobs, and registered nursing is the occupation expected to add the most employment. This projection translates to a need for 712,000 additional registered nurses nationally to meet the demand by the year The outlook in Kansas is similar to the national trend. The Kansas Department of Administration projects that the number of people age 55 and over is expected to grow by 88,000 from 2010 to 2020, which increases the demand for additional health care providers such as Registered Nurses. Despite a downturn in healthcare workforce demand, due to the recession experienced the last few years, the outlook for nursing employment opportunities continues to be favorable. The Kansas Occupational Outlook, published by the Kansas Department of Labor, identified the top ten occupations with the highest absolute change for projected growth through Registered Nurses are listed first, with a projected growth of 18 percent, or 5,910 additional RN positions needed by According to the Kansas State Board of Nursing, the largest population of registered nurses grouped by age, is in the 51 to 60 year old range, with the second largest population in the 41 to 50 year old range. This also reflects national data suggesting an aging nursing health care workforce. With an aging workforce nearing retirement, anticipated economic recovery and an increased demand in healthcare services, nursing is positioned for future occupational growth. The State of Kansas has anticipated this need by continuing the Nursing Initiative to address future demand. 9

13 NURSE EDUCATOR SERVICE SCHOLARSHIP PROGRAM Initiative funding is clearly making a positive difference in the lives of those that our PSU graduates serve. We appreciate the partnership among Pittsburg State University, The Kansas Board of Regents, and the State of Kansas Pittsburg State University FY13 Annual Report The goal of the service scholarship program is to increase the availability of qualified nursing faculty in Kansas postsecondary nursing education programs. Scholarship funds are awarded to applicants who agree to engage in full-time, or the equivalent to full-time, teaching in a Kansas program after receiving their Master or Doctorate degree in Nursing. This ongoing program is subject to annual appropriation from the Kansas Legislature. An annual total of $300,000 dollars is available ($200,000 grant funding plus $100,000 required match) for distribution to five eligible institutions that provide Master of Nursing or Doctorate in Nursing degree programs. Institutions indicate the number of service scholarships requested and agree to all conditions in the scholarship announcement. Individual scholarship amounts cannot exceed 70 percent of the cost of attendance (tuition, fees, required supplies and text) for an academic year. The Nurse Educator Scholarship Program, after seven years, has already demonstrated to be a wise investment for the state. The following table illustrates the results to date. Nurse Educator Service Scholarships Awarded AY 2007 AY 2013 Number of Total AY Number of Institution Awards Award Graduates Fort Hays State University 25 $37, Pittsburg State University 28 $87, University of Kansas Medical Center 37 $205, Wichita State University 50 $306, Washburn University 27 $198, Totals 167 $835, Summary of Nurse Educator Service Scholarships The demand for more nurse educators, combined with the appeal of this service scholarship program, attracts students in need of financial assistance who are pursuing their graduate education. Through the first seven years of this project, 167 service scholarships have been awarded. Of these 167 service scholarship recipients, 108 have graduated as of September 2012, 62 are employed as teachers at Kansas postsecondary institutions, 10 have fulfilled their teaching obligation and 19 are in repayment or have repaid their scholarship. The scholarship program has been in effect long enough that some of the students have completed their teaching obligation of the scholarship and have moved on to other pursuits. The growing popularity of this service scholarship program has the potential to ease the nursing faculty shortage by assisting with the production of new nurse educators. However, this grant does not address disproportionate salary differences between nurse educators and practitioners and this disparity has contributed greatly to the shortage of nursing faculty. 10

14 Having these funds allows for our being able to retain these fine clinical experts in our community as faculty, semester after semester. Due to this funding, we have been able to retain many of the same instructors for several years, lessening the amount of training and orientation needed Johnson County Community FY13 Annual Report NURSING FACULTY SALARIES AND SUPPLIES GRANT PROGRAM As with the Nurse Educator Service Scholarship Program, the primary goal of the Nursing Faculty Salaries and Supplies grant is to increase the availability of qualified nursing faculty in Kansas postsecondary nursing education programs. A second goal of this grant is to increase funds for consumable supplies necessary for laboratory and classroom instruction to accommodate an annual increase of 250 students in nursing student enrollment. This grant is subject to annual appropriation from the Kansas University of Kansas Medical Center Legislature, with the original request for proposals (RFP) spanning a 10 year period. Initially, this grant made available a total of $2.4 million ($1.2 million grant funds plus $1.2 million in required match) to hire additional nursing faculty and secure additional supplies. All 22 publicly-funded educational institutions in the state with approved RN programs were encouraged to apply for grant funding. Institutions applying for this grant provided: an implementation plan to demonstrate sustainability, a summative evaluation of the plan s success, and most importantly, an explanation describing how enhanced nursing program capacity would lead to a greater number of graduated nurses passing the NCLEX examinations. For FY 2008, the Kansas Legislature appropriated an additional $600,000, thus increasing the grant amount from $1.2 million to $1.8 million annually ($3.6 million total with required match). Each institution was invited to submit a supplemental grant proposal for this additional grant funding. Institutions applying for these supplemental funds had to demonstrate how they would utilize these additional funds and were held to the same accountability criteria as initial grant fund recipients. The same Nursing Initiative Grant Review Committee reviewed the proposals submitted for supplemental funds. For FY 2009, the Kansas Legislature appropriated an additional $100,000 for nursing faculty salaries and supplies intended for private nursing programs, thus increasing the grant amount to $1.9 million annually ($3.8 million total with required match). Each private institution with a nursing program was invited to submit a grant proposal for this additional grant funding. Four nursing programs at private colleges submitted proposals and were subsequently approved for funding. The following table illustrates the results to date. 11

15 Institution Barton County Community Brown Mackie Kansas City Nursing Faculty Salaries and Supplies Grant Data FY 2007 FY 2013 Grant Award Match Amount Spent Total Funds Amount Spent on Faculty Salaries Amount Spent on Supplies Total Spent Additional New Nursing Faculty FT Additional New Nursing Faculty PT $150,555 $202,296 $352,851 $314,793 $71,178 $385, $120,320 $143,813 $264,133 $264,133 $0 $264, Brown Mackie Salina $120,320 $241,522 $361,842 $361,842 $0 $361, Butler Community Cloud County Community Colby Community Dodge City Community $394,488 $456,801 $851,289 $734,778 $116,511 $851, $348,087 $371,196 $719,283 $719,283 $0 $719, $396,455 $597,124 $993,579 $942,198 $51,381 $993, $63,615 $162,078 $225,693 $155,779 $68,056 $223, Emporia State University $342,004 $471,406 $813,410 $876,392 $0 $876, Fort Hays State University Hutchinson Community Johnson County Community Kansas City Kansas Community Labette Community Manhattan Area Technical MidAmerica Nazarene University Neosho County Community North Central Kansas Technical /Hays $151,515 $151,515 $303,030 $290,714 $12,316 $303, $303,132 $312,073 $615,204 $615,204 $0 $615, $1,168,416 $1,224,222 $2,392,638 $2,392,639 $0 $2,392, $815,754 $1,074,231 $1,889,985 $1,889,985 $0 $1,889, $174,384 $282,560 $456,944 $456,944 $0 $456, $285,735 $328,632 $614,366 $609,566 $4,800 $614, $144,384 $197,040 $341,424 $341,424 $0 $341, $1,149,718 $1,156,626 $2,306,344 $2,244,254 $62,090 $2,306, $130,315 $184,171 $314,486 $314,486 $0 $314, Pittsburg State University $1,306,852 $1,317,700 $2,624,552 $2,228,416 $383,344 $2,611, Pratt Community $785,586 $817,731 $1,603,317 $1,603,317 $0 $1,603, Southwestern $58,231 $58,565 $116,796 $116,796 $0 $116, University of Kansas Med Center $908,236 $1,143,905 $2,052,141 $2,052,141 $0 $2,052, Washburn University $1,015,802 $1,016,305 $2,032,107 $2,014,581 $17,526 $2,032, Wichita State University $1,620,268 $1,772,341 $3,392,609 $3,289,135 $103,474 $3,392, $24,828,80 Totals $11,954,172 $13,683,853 $25,638,023 $890,676 $25,719, Note: all unspent grant funds were encumbered for expenditure in the following fiscal year. FT = Full Time; PT = Part Time 12

16 Summary of Nursing Faculty Salaries and Supplies Grant This grant provides funding for educational institutions to hire additional nursing faculty and secure additional instructional supplies. Based on fiscal year-end information submitted to KBOR from the 23 institutions that received funding from this grant, 263 full-time and 277 part-time additional nursing faculty have been hired since the beginning of this grant. A considerable number of full-time and part-time nursing faculty positions remain unfilled and several positions that were filled became vacant again due to turnover. Through FY 2013, institutions reported a total of $24,828,800 (grant with required match) was expended for nursing faculty salaries. Nursing faculty positions continue to be exceedingly difficult to fill. Several institutions have reported turnover due to competition for nursing faculty among institutions and the disparity between faculty and practitioner salaries. Other challenges with recruiting and retaining nursing faculty include: Faculty turnover due to relocation out of state or retirement; Additional educational requirements required to become a nurse educator; and Increased vacancies due to additional faculty positions. NOTE: not all public nursing programs applied for funding from this grant; however, KSBN surveyed all nursing programs, public and private, so this faculty data reflects statewide trends. The funding received through the Kansas Nursing Initiative remain an essential factor in maintaining increased admission numbers for our program and meeting requirements of the accrediting and approving agencies particularly the requirements that relate to faculty/student ratios and adequate clinical learning opportunities. Emporia State University FY13 Annual Report Nursing Supplies A total of $890,676 (grant with required match) has been expended on nursing classroom supplies. The vast majority of classroom supplies purchased included consumable supplies, such as gloves, syringes, catheters, surgical dressing kits, gauze, IV bags, chemical testing strips, and other single or limited-use items. These consumable items are necessary for learning proper and safe patient-care procedures. NURSING EQUIPMENT AND FACILITY UPGRADES GRANT PROGRAM One goal of the Nursing Equipment grant was to provide for new technology and equipment, such as patient simulators, and sophisticated patient monitors in nursing classrooms. A second goal of this grant was to assist with enhancements to physical space, both classroom and laboratory, which would accommodate an increase in nursing student capacity. This was a one-year grant, not subject to renewal, which made available a total of $3 million ($2 million grant funds plus $1 million in required match) to secure necessary equipment and address facility space requirements. All 22 publicly-funded educational institutions in the state with approved RN programs were encouraged to apply for the grant. Applications provided an implementation plan to demonstrate sustainability, as well as a narrative detailing how 13

17 nursing education programs would increase capacity and graduate more nurses who would pass the NCLEX examinations...this grant provided our institution augment clinical experience with simulation, critical thinking, and application opportunities. In essence, this grant has benefited our school and community in an era of constricted clinical practicum placement. Fort Hays State University FY13 Annual Report Summary of Nursing Equipment and Facilities Upgrades Grant for FY 2007 This grant provided educational institutions financial support to purchase needed equipment and the ability to invest in facility modifications, assisting institutions in their ability to accommodate an increase in nursing students. This grant, unlike the Nursing Salaries and Supplies grant, was a one-time appropriation. Of the 18 institutions applying for this grant, all requested funding for additional equipment and eight institutions also requested funding for modifications to their facilities. The creation of patient simulator laboratories represented the majority of facility modifications. Other institutional modifications included expansion of skills laboratories and increased nursing classroom space. One institution, North Central Kansas Technical /Hays campus, requested and received support to significantly enlarge the building which housed the nursing program. For FY 2007, institutions reported total expenditures for equipment (grant with required match) of $2,674,548 and total expenditures for facility modifications (grant with required match) of $622,247, for a grand total of $3,296,795 in expenditures. It is interesting to note that nine institutions increased their match funding, primarily for additional equipment, thus increasing the grand total of this funding investment by $296,795. MidAmerican Nazarene 14

18 Nursing Equipment and Facilities Upgrades Grant Data FY 2007 Institution Grant Award Match Amount Total Available Amount Total Amount Spent Total Amount Spent for Equipment Total Amount Spent for Facility Modification Emporia State University $75,000 $41,604 $116,604 $116,604 $116,604 $0 Ft. Hays State University $100,000 $50,441 $150,441 $150,441 $53,939 $96,502 Pittsburg State University $302,245 $151,123 $453,368 $453,368 $392,944 $60,424 Washburn University $62,158 $33,079 $95,237 $95,237 $65,237 $30,000 Wichita State University $96,673 $48,901 $145,574 $145,574 $84,082 $61,492 Barton County Community $75,271 $37,636 $112,907 $112,907 $112,907 $0 Butler Community $45,629 $33,692 $79,321 $79,321 $79,321 $0 Cloud County Community $7,950 $7,950 $15,900 $0* $0* $0* Colby Community $44,762 $22,382 $67,144 $67,144 $66,111 $1,033 Ft. Scott Community Garden City Community Hutchinson Community Johnson County Community Kansas City KS Community Manhattan Area Technical Neosho County Community North Central Kansas Technical /Hays $50,250 $35,568 $85,818 $85,818 $13,724 $72,094 $160,211 $80,105 $240,316 $240,316 $240,316 $0 $60,000 $36,792 $96,792 $96,792 $96,792 $0 $326,245 $405,111 $731,356 $731,356 $731,356 $0 $172,973 $113,425 $286,398 $286,398 $286,398 $0 $33,554 $17,007 $50,561 $50,561 $50,561 $0 $130,976 $65,488 $196,464 $196,464 $193,460 $3004 $199,033 $99,500 $298,533 $298,533 $835 $297,698 Pratt Community $57,070 $32,891 $89,961 $89,961 $89,961 $0 Totals $2,000,000 $1,312,695 $3,312,695 $3,296,795 $2,674,548 $622,247 * Denotes grant funds were not expended and returned to State 15

19 BUILDING NURSING EDUCATION SIMULATION CAPACITY IN KANSAS The traditional approach to educating healthcare professionals relies heavily on hands-on training with actual patients in multiple clinical settings. Clinical practice is, and will remain, an integral component of nursing education. It does, however, have its inherent limitations, such as patient safety concerns, limited exposure to the variety of patients and conditions one might encounter at a clinical site, and inconsistent learning opportunities. Neosho County Community The challenges of placing more students into a finite number of clinical learning sites and the desire to give students more opportunities to practice specific skills, work through clinical problems, and make decisions in a safe and controlled environment, resulted in an emphasis on obtaining high-fidelity patient simulators for nursing programs. Human patient simulators are full-body computerized mannequins that provide realtime physiological measurements programmed to reflect a variety of health conditions. These simulators allow students to practice specific clinical skills repeatedly, evaluate their knowledge base, develop critical thinking and teamwork skills, and gain exposure to scenarios that they might not be exposed to during their actual clinical experiences. Just as flight simulators in the aviation industry proved to be tremendously useful in pilot training and improving overall aviation safety, the use of simulation technology in healthcare proves to be equally useful in educating new Johnson County Community students and existing professionals. As a direct result of the Kansas Nursing Initiative, statewide simulation activity has increased dramatically over the past seven years. Prior to the initiative, a small number of nursing education programs around the state took an early lead in promulgating simulation and encouraged others to follow. While faculty members were convinced of the validity of incorporating simulations into their respective nursing curricula, the majority of the nursing programs statewide had not purchased high-fidelity human patient simulators and, of those programs with simulators, only a few were using them to their fullest capability. To realize the full potential of simulator-based nursing education, programs needed a dedicated space for a simulation laboratory, as well as faculty training on simulator operation and clinically relevant patient simulator scenarios. With grant funding, institutions purchased human patient simulators and related ancillary equipment, such as compressors, computers, monitors and audio-visual equipment, and several institutions remodeled their nursing facilities to create simulation laboratories, which are fully- equipped replicas of clinical settings. In conjunction with KSBN, simulation workshops have been conducted to assist nursing and allied health faculty with development of clinically relevant scenarios utilizing patient simulators and to develop reliable student assessment modalities. Over the past seven years, a tremendous surge has occurred, not just in the acquisition of human patient simulators by nursing education programs throughout the state, but also in the integration of simulators into the curriculum. As such, the use of a human patient simulator is becoming a routine part of nursing and allied health education. Students are utilizing simulations to achieve and reinforce specific learning objectives and concepts and acquire 16

20 skills they would otherwise obtain only in an actual clinical site. The use of human patient simulators in Kansas has crossed a threshold point -- faculty are becoming more familiar and comfortable with their use and simulators are becoming fully embedded in every program curriculum. A map denoting the locations of Kansas nursing programs with human patient simulators is located in Appendix III of this report...we are now more aware than ever of the importance of the use of simulation in nursing programs. We have increased our number of full and part-time faculty in the simulation center to accommodate our teaching needs for this coming academic year. Johnson County Community FY13 Annual Report INCREASED ENROLLMENT IN NURSING EDUCATION PROGRAMS The primary goal of the Kansas Nursing Initiative, funded by these grants and their respective match, was to increase the enrollment in and the graduation from Kansas registered nursing (RN) education programs. Increasing the capacity of nursing programs has impacted the waiting lists of qualified students seeking admission into these programs. Many institutions, both two and four year, reported that the number of students placed on waiting lists has decreased as programs were able to accommodate more students. Additionally, some nursing programs placed added resources toward reducing attrition. This has and will contribute to more graduates and licensed practicing nurses in Kansas. To evaluate the effectiveness of the Nursing Initiative, admissions at institutions for the year prior to grant implementation were used as the baseline number for comparing results in succeeding years. Public institutions began receiving grant funds in FY 2007, so for comparison purposes, FY 2006 admissions were established as the baseline. Private institutions began receiving grant funds in FY 2009, with FY 2008 admissions determining the comparison baseline numbers. The following table illustrates the results to date. 17