Nursing Education Programs Annual School Report

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1 STATE OF WASHINGTON DEPARTMENT OF HEALTH Nursing Education Programs Annual School Report Statistical Summary and Trends Analysis Nursing Care Quality Assurance Commission DOH (Revised April 2015) Public Health Always Working for a Safer and Healthier Washington

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3 Table of Contents Executive Summary... 5 Survey Background... 5 Survey Participants... 5 Data Summary Pre-Licensure Program Statistics... 6 Graduates... 7 Demographic Data ( )... 8 Race-Ethnicity... 8 Student Age... 8 Clinical Hours... 8 Clinical Hours: Direct Care, Observational and Simulation... 9 Clinical Placement Washington State Nursing Licensure Information NCLEX Test Takers Number of People Licensed or Certified Post-Licensure Program Statistics ADN to RNB Master s Nursing Degrees Doctoral Graduate Nursing Programs Demographic Data Race-Ethnicity Post-licensure Student Age Nursing Faculty Statistics Demographic Data Education Level Summary and Discussion References:... 20

4 Acronyms ADN... Associate Degree in Nursing ARNP... Advanced Registered Nurse Practitioner BSN... Bachelor of Science in Nursing Registered Nurse LPN.... Licensed Practical Nurse GE... Graduate Entry Programs Registered Nurse MSN/MN...Master s of Science Nursing NCLEX.... National Council Licensure Examination NCQAC.... Nursing Care Quality Assurance Commission RN... Registered Nurse RNB... Registered Nurse Bachelor s (Bachelor s degree programs for licensed RNs) PMCNP... Post Master s Certificate Nurse Practitioner DNP... Doctorate of Nursing Practice MN... Masters of Nursing MS... Master of Science PN to AD... LPN program with an AD completion AD to PN... Associate degree program with a LPN step out

5 Nursing Programs Annual Report Academic Year Executive Summary Survey Background The Nursing Care Quality Assurance Commission (NCQAC) requires all nursing programs to report annually [WAC (3)]. This report summarizes data and data trends from approved Washington State nursing programs for the academic year. Survey Participants Forty-three approved nursing schools (30 community or technical colleges and 13 universities) completed the annual survey, representing 89 nursing programs. Forty-six of the 89 programs prepare graduates for LPN or RN licensure. There are seven licensed practical nurse (LPN) programs and 28 associate degree registered nurse programs, either as a generic ADN or with an LPN component. Nine universities offer bachelor of science in nursing (BSN) programs. Two of the university programs offer graduate entry (GE) options. The remaining 43 programs prepare graduates to advance their education post-licensure. There are eight RNB programs, two ADN to MSN, six ARNP and 10 other master s programs. Finally there are five post master s certificate programs, five doctoral of nursing practice (DNP) and two Ph.D. programs. There is one LPN to BSN and the remaining four programs were listed in the other category. Data Summary All nursing program levels received more qualified applicants for admission than space allowed. Forty-nine percent (3500) of the total qualified applicants (7,219) were offered admission to prelicensure programs and 71 percent of those admitted started their course work the same year. Post-licensure programs, including RNB and all MN programs combined, admitted 94 percent of qualified students who applied, and 100 percent of students began their coursework. The DNP and Ph.D. programs admitted 81 percent, or 218 of 268, qualified students and 70 percent of those admitted (160) started their coursework. Attrition rates decreased as the level of educational preparation increased. There were fewer students leaving BSN and higher educational programs than LPN or ADN programs. The attrition rate data were consistent with the previous eight years of data. Pre-licensure programs (LPN, ADN, BSN and GE) produced 3,076 graduates over the academic year. The number of BSN graduates increased since from 856 to 1,075 and ADN graduates increased from 1,179 to 1,671. The number of LPN graduates declined from 634 in to 330 in

6 The number of nurses graduating from all post-licensure programs increased in every category when compared with There were 466 graduates of RNB programs in and 930 students were enrolled in RNB programs which is an increase from 383 graduates and 550 enrolled the previous year. The number of ARNP graduates with a master s degree went from 175 the previous year to 187 during The number of master s degree graduates (not ARNP) increased to 257 from 136 during year , which may reflect reporting from more programs. The graduates from doctoral programs was 72 (58 DNP, 14 Ph.D.) as compared to 55 (40 DNP, 15 Ph.D.) the previous year. Demographic data on students showed the majority of pre-licensure students are white women. Students in LPN programs had greater diversity than RN programs. BSN programs had younger students, while LPN and ADN programs reported a wider range of age diversity among enrolled students. Nursing programs continued to report difficulty filling nursing faculty positions. Programs reported that 14 percent of nursing faculty members anticipate retiring in the next five years, which is more than the 10 percent reported from the previous year. Fifty-nine percent (629) of nursing faculty in Washington State have a master s degree as their highest degree. Twenty-four percent (265) of nursing faculty members have doctoral degrees and 17 percent (184) have a baccalaureate degree as their highest degree. Nursing faculty members are primarily white- Caucasian females over the age of 55. Fewer nursing programs reported difficulty finding clinical practice placements for students. Fifteen nursing schools reported clinical site placements are not adequate, compared to 30 schools the previous year. Using lab simulation and a broader range of settings was reported as a means of providing practice experiences when clinical placements sites were a challenge. Twenty-one of the 30 community or technical colleges and all 13 universities have national nursing accreditation. Data trends over time, as well as key findings from this survey, are illustrated below. When appropriate, additional national or state data will be provided for illustration and comparison Pre-Licensure Program Statistics The Institute of Medicine Report (IOM) [2010] titled The Future of Nursing identifies that nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Data from AACN s fall 2014 survey of baccalaureate and graduate nursing programs found enrollment growth across the board, including a 4.2 percent increase in students in entry-level baccalaureate programs (BSN). Washington state nurse education has responded to this national call as shown by the increase in numbers of graduates in all levels of registered nursing. The number of pre-licensure BSN graduates has increased 26 percent in the previous year from 856 to

7 Graduates Trends in the number of pre-licensure graduates from academic years through are illustrated below: In , practical nursing programs (LPN) had 330 graduates, a decrease from 634 graduates the previous year. Since 2001, the number of graduates from associate degree nursing programs (ADN) has more than doubled. In , ADN programs graduated 1,672 students, an increase from 1,179 graduates the previous year. The number of bachelor of science in nursing (BSN) and graduate entry (GE) programs graduates has almost tripled since In , BSN-GE programs graduated an increase to1,075 graduates as compared to 856 the previous year. The total number of graduates from programs preparing students for the registered nurse (RN) licensure (ADN, BSN and GE) in Washington State has continued to increase over the past nine years. There were 2,747 graduates from RN programs in compared to 2,035 graduates in Figure 1: Total Pre-Licensure Program Graduates by Type of Program LPN AD-RN BSN/GE

8 Demographic Data ( ) Race-Ethnicity Students in practical nurse (LPN) programs were slightly more diverse when compared to other pre-licensure programs in race-ethnicity demographics. Figure 2: Pre-Licensure Student Race-Ethnicity Demographics by Program White Caucasian BSN Black / African American Asian AD Native Hawaiian / Other Pacific Islander Hispanic / Latino PN 0% 20% 40% 60% 80% 100% Mixed Race American Indian / Alaskan Native Student Age Almost 75 percent of all students in graduate entry (GE), ADN and LPN programs were older than 25 years of age whereas only 20 percent of BSN students are over 25 years of age. Clinical Hours The rules governing nursing pre-licensure education in Washington State do not specify a minimum number of clinical or theory hours for the required content areas. All programs are required to have clinical or practice hours across the lifespan to include pediatric, obstetric, mental health, community health and medical-surgical experiences. The average number of clinical hours in LPN programs is 398, with a range of The average number of clinical hours in ADN programs including PN with ADN, ADN with PN and ADN programs is 533, with a range of 292-1,156. The average number of clinical hours in the BSN programs is 702, with a range of The breakdown of the average clinical hours by program type and content area is below. 8

9 Table 1: Average and Range of Total Clinical Hours by Program PN PN AD AD PN ADN BS GE Average Range , Clinical Hours: Direct Care, Observational and Simulation The programs identified access to quality clinical learning experiences as a major concern. Data were collected to provide information as to the type of clinical experiences and hours students spent in these settings. The data are organized by both content area and type of nursing program. Figure 3: Average Direct Care Clinical Hours by Content and Program Direct Care Figure 4: Average Observation Clinical Hours by Content and Program Ob Mat Infant Peds Psych Med Surg Role Observation Ob Mat Infant Peds Psych Med Surg Role BS AD PN Figure 71 5: Average Simulation 93 Clinical Hours by Content and Program BS AD PN 9

10 Figure 5: Average Simulation Clinical Hours by Content and Program Simulation Ob Mat Infant Peds Psych Med Surg Role BS AD PN Overall direct care experiences make up an average of 85 percent (458) of the total clinical experience hours in all pre-licensure programs. Clinical observation makes up 4 percent (23) and simulation 11 percent (59) of the total hours required. Table 2: Percent of Total Clinical Hours in Direct Care, Observation and Simulation. Percent Direct Care 85 Observation 4 Simulation 11 Clinical Placement Fifteen programs reported inadequate clinical sites for students that reflect a decrease from 30 programs reporting inadequate clinical sites the previous year. Programs reported that some providers expressed a preference for BSN students. Higher program enrollments were also reported to affect the ability to maintain clinical placements for ADN programs. Obstetrics and pediatrics were identified as the most difficult clinical placements to find. 10

11 Table 3: Total Number of Programs Reporting Inadequate Clinical Sites Number of Schools Reporting Inadequate Clinical Sites Nursing programs report managing clinical placement of students by participating in regional clinical consortiums, increasing the amount of simulation or lab time, maintaining good relationships with and networking with facilities, working evenings, weekends or other shifts, finding placements outside the consortium, using community health placements, working to coordinate placements with other universities or colleges, expanding the clinical experience in other practice settings, and using more hours of preceptorship. Washington State Nursing Licensure Information Successful completion of the national state board exam (NCLEX) is required in all states prior to LPN or RN licensure. The 2014 Washington State NCLEX pass rates are provided below for comparison. Students may take the NCLEX exam in any state, so graduates from Washington State may test in another state. The NCLEX pass rates are also reported by calendar year rather than academic year. In addition, the total number of licensed nurses and certified assistants in 2013 and 2014 are provided below for further illustration and comparison NCLEX Test Takers Over the past 13 years, the number of LPN graduates taking the NCLEX-PN test in Washington ranged from a low of 579 in 2001 to a high of 1,063 in During there were the fewest test takers since 2001 (675). Over the past 13 years, there has been a steady increase in the number of first-time NCLEX-RN test takers for ADN graduates. In 2001, 487 graduates took the test. The highest number of test takers was in 2011 with 1,770 graduates taking the test. There were 1,759 graduates from ADN programs who took the test for the first time in Since 2008 this number has been stable. Over the past 13 years, the number of BSN-GE graduates taking the NCLEX-RN test has nearly doubled from 484 to 885 graduates in 2014, a slight decrease from 907 in Over the past 12 years, with the exception of 2011, there were yearly increases in the total number of RN students taking the NCLEX test for the first time (from 971 graduates to 2,644 graduates). LPN totals have shown little net change over this same period. Although both ADN (487 to 1,759) and BSN (484 to 885) program totals have increased, the ADN programs increased more than the BSN programs. Those taking the NCLEX for the first time went from nearly equal numbers from ADN (487) and BSN (484) program in 2001 to almost twice as many from ADN programs (1,759) as those from BSN programs (885). 11

12 Figure 6: Total Number of NCLEX First-Time Test Takers LPN AD-RN BSN/GE Number of People Licensed or Certified The total number of nurses and nursing assistants has stayed stable. The numbers includes students and nurses completing nursing programs in Washington, other states and territories, and other countries. Figure 1: Licensed Nurses and Certified Assistants ARNP RN LPN NAC NAR ARNP (Advanced Registered Nurse Practitioner) RN (Registered Nurse) LPN (Licensed Practical Nurse) NAC (Nursing Assistant Certified) NAR (Nursing Assistant Registered) 12

13 Post-Licensure Program Statistics The Institute of Medicine Report (IOM) [2010] titled The Future of Nursing, identifies the need for seamless educational opportunities for nurses. The report states that licensed nurses must be able to progress in their educational preparation without barriers that prohibit or limit this opportunity. Healthcare requires a well-educated nursing workforce. WAC (1) requires nursing programs to participate in a statewide articulation plan. This plan facilitates the educational advancement of nurses across the various levels of nursing education. For example, all LPN programs in Washington State have articulation agreements with either ADN or BSN nursing programs. ADN programs have articulation agreements with BSN or AD-RN MSN programs. Data from American Association of Colleges of Nursing (AACN) s fall 2014 survey of baccalaureate and graduate nursing programs found enrollment growth across the board, including a 10.4 percent increase in RN-to-BSN programs for registered nurses looking to build on their initial education at the associate degree or diploma level. In graduate schools, student enrollment increased by 6.6 percent in master s programs, as well as by 3.2 percent and 26.2 percent in research-focused and practice-focused doctoral programs, respectively. Washington state nursing schools exceed the increases seen nationally. The addition of two new RN to BSN programs, and an increase in enrollment and graduations of RN to BSN programs has resulted in a 69 percent increase in enrollment (550 to 930) and a 22 percent increase in graduates (383 to 466). Graduations have increased in master s (42 percent) and doctoral programs (31 percent) responding to the shortage of nurse faculty, primary care providers, and researchers. ADN to RNB The number of RNB graduates in Washington schools rose sharply in academic year and continued through with 466 graduates. In , 930 students were enrolled in RNB programs, an increase from the previous year reported. The number of ADN to RNB graduates from out-of-state online educational programs is not yet available. The Nursing Commission began approval of out-of-state nursing programs for clinical site placements in January 2013 and is gathering data. Preliminary information from the out-of-state programs is available on the Nursing Commission website (http://www.doh.wa.gov/licensespermitsandcertificates/nursingcommission/nursingeducation/ NursingPrograms). 13

14 Figure 7: Number of Graduates and Enrolled RNB Students by Year RNB Graduates RNB Enrolled Master s Nursing Degrees There were 173 master s prepared advanced registered nurse practitioner graduates in The most common practice area among new ARNP graduates was family nurse practitioner (138), followed by adult nurse practitioner (10), and psychiatric mental health nurse practitioner (five). Master s degree programs in nursing (not ARNP) prepare registered nurses for research, healthcare administration, public policy, clinical specialties, faculty positions and for a variety of leadership roles in healthcare. Of the 257 who graduated in , 104 graduated from a nurse educator track. Over the past eight years, the number of graduates from a nurse educator track remained relatively steady with a range of 32 to 48 graduates until this year, when the number of graduates was 104. If this rate of graduates from the nurse educator track continues, it may partially help address the lack of available qualified faculty reported by nursing programs during this reporting time. 14

15 Table 4: Total Number of Nursing Education Master s prepared Graduates by Year Total Number of Nursing Education Graduates by Year Doctoral Graduate Nursing Programs Programs reported that 72 people graduated (58 DNP and 14 PhD) with a nursing doctorate in During this same reporting period, programs reported that 168 doctoral students were admitted. Figure 8: Post-Licensure Total Number of Graduates by Program RNB MSN MSN/ARNP PhD/DNP

16 Demographic Data Race-Ethnicity In all post-licensure programs, the majority of students were white-caucasian, followed by Asian and black-african American. Figure 9: Post-Licensure Program Student Race-Ethnicity Demographics White Caucasian Doctoral Asian Black / African American MN RNB 0% 20% 40% 60% 80% 100% Native Hawaiian / Other Pacific Islander Hispanic / Latino Mixed Race Post-licensure Student Age Fifty four percent of students in all post-licensure program types are between years of age and 15 percent are between Nursing Faculty Statistics Increasing the number of graduates from a pre-licensure and post-licensure nursing program requires increased numbers of nursing faculty members. Washington State regulations require a minimum of a master s degree in nursing or a bachelor s degree in nursing and a master s degree in a related field to teach registered nursing. Practical nursing faculty must have a minimum of a bachelor s degree in nursing. National studies continue to show an increasing shortage of nursing faculty members nationwide, with all projections being that this shortage will increase. Washington State nursing programs are experiencing increasing difficulty in hiring nursing faculty members. Strategies to retain and attract nursing faculty members continue to be explored by nursing programs. Workload adjustment, sharing faculty, support for ongoing academic endeavors, and professional development are the major strategies reported to address the problem. Beyond the need for increasing nursing faculty pay, nursing programs identified faculty workload adjustment around the rigors of clinical instruction, committee work, and mentoring of new faculty members as areas critical to program continuation or expansion. The survey results indicate adequate qualified faculty to meet current needs, but impending retirements and projected needs will threaten this current balance and present further challenges to increasing education capacity and access. 16

17 Demographic Data Ninety-one percent of the faculty members were women and 96 percent were white-caucasian. Nursing programs reported 1,072 faculty members employed during academic year. There were 488 full-time faculty members and 584 part-time faculty members. Figure 10: Nursing Programs Faculty Race-Ethnicity Demographic Hispanic / Latino Mixed Race Missing / Unknown American Indian / Alaskan Native Asian White Caucasian Black / African American Native Hawaiian / Other Pacific Islander Twenty-one percent of nursing faculty members are more than 60 years old, 57 percent are more than 50 years old and 80 percent are more than 40 years old. Nursing programs reported that about 14 percent (151) of their nursing faculty members are anticipating retiring in the next five years. Given the difficulty nursing programs are having finding nursing faculty members, these retirements will only exacerbate the nursing faculty shortage. Figure 11: Faculty Age 71 or older or younger 0% 10% 20% 30% 40% 17

18 Education Level Twenty-four percent (265) of nursing faculty have doctorates (e.g. Ph.D., doctor of nursing practice, or non-nursing doctorates), which is up 5 percent from the previous year. Fifty-nine percent (629) of nursing faculty members were prepared at the master s degree level of education. Seventeen percent (184) of nursing faculty members had a BSN as their highest degree. Figure 12: Nursing Program Faculty Level of Education Doctoral Master's Baccalaureate Salary is reported as a barrier to successful recruitment and retention of nursing faculty. As a result, respondents answered the following questions for the first time this year. 1) What is the average salary for full-time faculty in teaching positions? and 2) What is the salary range for full-time faculty in teaching positions? The majority of schools reported full-time nine-month appointments. Where schools reported monthly or 12-month salaries, the totals were adjusted to approximate nine-month appointments. Community and technical college faculty average salary was $56, and the university schools reported an average faculty salary of $69, The range of salaries reported for nine-month appointments were from a low of just less than $30,000 to a high of near $180,000. Figure 13: Average Salary for Full Time Nine Month Teaching Position University Average Community College Average $10 $20 $30 $40 $50 $60 $70 Thousands 18

19 Summary and Discussion Across settings, nurses are being called upon to coordinate care and collaborate with a variety of health professionals, including physicians, social workers, physical and occupational therapists, and pharmacists, most of whom hold master s or doctoral degrees. (IOM 2011) The Future of Nursing: Leading Change, Advancing Health Research shows that a more highly educated RN workforce can benefit patient care overall (Akins, 2003, 2011, 2014; Needleman 2009; Kutney-Lee 2013) and may reduce costs (Yakusheva 2014). Washington State RNB, master s, and doctoral enrollments and graduations have increased significantly, adding to a higher educated workforce. An area for attention in Washington is the 41 percent increase (1,179 to 1,671) in the number of graduates from associate degree programs of nursing. Auerbach, Beurhaus, and Staiger (2015) found that the percentage of BSN-prepared nurses in acute care hospitals is increasing, while the employment of associate degree nurses in these settings is decreasing. Further, AACN s special survey on the Employment of New Nurse Graduates conducted last fall found that 79.6 percent of employers are now requiring or expressing a strong preference for nurses with a baccalaureate degree. Given these trends, education programs must use innovative strategies to assure associate degree graduates are able to progress directly to the BSN. The makeup of our patients is diverse, and the makeup of nurses should reflect this diversity, yet 90 percent of nurses are women and 96 percent of faculty and more than 70 percent of students are Caucasian. We are clearly not representing the diversity of the populations we serve. Those students and faculty in PN and ADN programs are slightly more diverse than those in universities, representing an opportunity to retain these students and faculty as they advance their education. Review of annual state data and trends provides information for planning and evaluation. Research data is now available indicating a need for a higher education level of nurses in the future. Increases in enrollment and graduations have responded to nursing shortages and met current needs, but the future needs will require creative solutions to provide more BSN prepared nurses. Recruiting and retaining qualified diverse faculty will also be essential to achieve an increased education level for the diverse nursing workforce we need now and in the future. 19

20 References AACN Employment of New Nurse Graduates (2014) Aiken LH, Sloane DM, Bruyneel MS, et al., for the RN4CAST consortium Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet, 383(9931): Aiken LH, Cimiotti JP, Sloane DM, et al Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care, 49(12): Aiken LH, Clarke SP, Cheung RB, et al Education levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290(12): Auerbach, D., Buerhaus, P., and Staiger, D (2015). Do Associate Degree Nurses Fare Differently in the Nurse Labor Market Compared to Baccalaureate Prepared RNs? Nurse Economics, 33(1), Charting Nursing s Future The Case for Academic Progression issue (http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407597). Kutney-Lee A, Sloane DM, and Aiken LH An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality. Health Affairs, 32(3): Needleman J and Hassmiller S The role of nurses in improving hospital quality and efficiency: real-world results. Health Affairs 2,8(4):w625-w633. Yakusheva, O., Lindrooth, R., Weiss, M Economic Evaluation of the 80 percent Baccalaureate Nurse Workforce Recommendation A Patient-level Analysis. Medical Care, 52 (10). 20

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