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

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

2 Preparing for this Third Meeting The New Yorker, May

3 So, where are we?? Several facts about NC nursing educational programs have been established and better understood.? Once understood, these facts have led to the identification of a number of problems or issues that need attention if NC nursing educational programs are to be strengthened, enlarged, or their productivity is to be increased.

4 First,? Some principles or planning assumptions to guide our consideration of these educational program issues...

5 Principles/Planning Assumptions? RN-oriented nursing education programs in NC Community Colleges (offering the ADN) and in four-year colleges and universities (offering the BSN) and in hospital-based programs are recognized as different types of programs serving different student populations,, though each may be educating students with similar immediate career orientations (obtaining a license to practice as a Registered Nurse).

6 Principles/Planning Assumptions? It is important to maximize the utilization of existing resources available for nursing education in NC. For example, high attrition rates indicate that current faculty or facilities are not being effectively utilized.

7 Principle/Planning Assumption? The goal of the nursing workforce effort should be to increase the total number of licensed, practicing nurses throughout NC.

8 Principle/Planning Assumption? In addition to the numbers of additional nurses needed, we need to give consideration to the diversity of nursing roles,, and associated educational preparation needed for these roles.

9 Principles/Planning Assumptions? There is a need to seek an increasingly diverse array of clinical teaching sites/opportunities for preparing the nursing workforce of the future.? There is a need to creatively define and examine how we utilize these clinical experiences for nursing training, including the effective use of clinical teaching technologies.

10 Principles/Planning Assumptions? It is important to incorporate the needs and perspectives of nursing employers in the process of program/curriculum development and innovation to prepare the nursing workforce of the future.

11 Second, some initial observations Opening a can of worms

12 Observations we have made:? NC has more than 90 separate nursing educational programs currently in operation.? These programs offer nursing educational credentials at every level (Nurse Aide I and II, Diploma, ADN, BSN, MSN, PhD).

13 Observations we have made? ADN and BSN programs are probably recruiting from very different populations of potential nursing student applicant pools, both for a two-year nursing educational experience beyond the date of enrollment. ADN applicants, enrolled students and graduates are older than BSN applicants, enrolled students and graduates. BSN programs are usually taking students into the program after they have completed two years of arts & sciences curricula (at these or other institutions).

14 Observations we have made:? There are articulation arrangements through which graduates of most of these levels of nursing education can advance to other levels as their career orientations and preferences change.? Greater than 60% of all Registered Nurses in North Carolina received their professional entry- level nursing education through one of the ADN programs in one of the state s Community Colleges.

15 Observations we have made? RN-to to-bsn programs may be recruiting students from a pool of former graduates of ADN programs, who are themselves among the minority of total applicants to these ADN programs by virtue of their completion of these programs.

16 Observations we have made:? Community College ADN programs receive far more applications than they can admit, and use practically all (97%) of their slots approved by the NC Board of Nursing.? BSN programs receive many fewer applications (usually after two years of undergraduate general studies at these or other colleges) and admit a higher percentage of those who apply.

17 Observations we have made:? However, BSN programs appear to be using only 74% of the slots approved by the NC Board of Nursing,, indicating that there may be as much as 25% unused capacity in these programs.

18 Observations we have made? It appears that as many as 49% of ADN students in Community College cohorts fail to complete these programs and graduate, while only 12-25% 25% of expected BSN students fail to complete their studies and receive their degrees. Reasons for curricular attrition in each of these programs and interventional options need to be explored by the Task Force.

19 Observations we have made:? For those who graduate from hospital-based diploma programs, ADN programs or BSN programs, pass rates for the NCLEX examination are high and comparable.? The prospects for eventual employment in nursing in North Carolina vary considerably among different types of nursing educational programs: (ADN = 81%; BSN =74% ; Diploma = 66%).

20 Observation? PNE (LPN) programs appear to be graduating only 49% of those they might be expected to graduate each year. (Note: do not have data available on applicants, acceptances or enrollment in these programs at the present time.)

21 Observation? North Carolina has experienced a trend toward decreasing percentages of newly licensed and practicing RNs having received their nursing education in NC (1995 = 61%; 1996 = 59%; 1997 = 60%; 1998 = 58%; 1999 = 56%; 2000 = 55%; 2001 = 55%). Given the fact that surrounding states are expected to experience shortages of nursing personnel sooner than NC, this reliance on nurses trained in other states may become a serious problem for our state in the not-too too-distant future.

22 Observation? There are areas of specialty nursing practice that are in need of additional personnel (e.g., schools, public health, mental health, geriatrics) and these needs should be addressed by the Task Force.

23 A number of developments worth noting re. nursing education in NC:? New 2 nd -degree BSN programs at ECU, Duke and UNC-CH CH (requiring months of intensive study and practicum experience)? Advance placement ADN programs can now be completed in 12 months (available in XX Community Colleges)? New LPN programs beginning in 5 Community Colleges, bringing the total number to 34; two more programs are seeking approval (and total student population in these programs to 1,200).

24 Further new developments? There are now 32 training programs for Nurse Aides in the NC Community College System.? These programs graduated more than 11,000 nursing assistants last year.? AHEC and College Foundation program for stimulating interest in nursing among high school students

25 Further developments? The Nurse Education Scholarship-Loan Program funded by the NC General Assembly in 1989 and administered through the NC State Education Assistance Authority (intended to provide financial aid to students with need).? The Nurse Scholars Program,, also funded by the General Assembly in 1989 is a merit-based scholarship/loan program based on superior academic and leadership potential. Recipients enter into contract with State to practice nursing in NC in order to cancel loan payments.? Unlike the NC Teaching Scholars Program, these programs may not use unused scholarship money for support of extracurricular activities or summer experiences to increase commitment to nursing as a career.

26 An attempt to understand the process and outcomes of nursing education Application Acceptance/Rejection Enrollment White Non-White Met admission requirements Did not meet admission requirements Met admission requirements Did not meet admission requirements Prerequisites not met Grades or other admission criteria not met Prerequisites not met Grades or other admission criteria not met Took prerequisites & re-applied Took prerequisites & re-applied Accepted Not accepted Withdrew appl. or entered elsewhere Accepted Not accepted Withdrew appl. or entered elsewhere Enrolled Space unavailable Enrolled Space unavailable

27 Graduation Pass Rate Employment NCLEX In nursing in NC CURRICULUM White Non-White % % Total % Total In nursing outside NC Not employed in nursing In nursing in NC In nursing outside NC Not employed in nursing In nursing in NC The key question is: Do we have enough master s degree faculty to operate these programs? In nursing outside NC Not employed in nursing

28 Another way to diagram the educational process: Pre-Nursing Courses & Nurse Aide I course Prerequisites Not Met Prerequisites Not Met Pre-Nursing Courses taken Application ADN Program Prerequisites Met Inquiry to ADN Program Inquiry to BSN Program Application To BSN Program Acceptance To BSN Program Acceptance To ADN Program ADN Employment In or Out of Nursing Interest in Nursing Employment In or Out of Nursing BSN Completion of Jr & Sr Year Nursing Curriculum Complete 2-year AND Curriculum NCLEX RN Licensure RN Licensure NCLEX

29 Pre-Nursing Courses & Nurse Aide I course Prerequisites Not Met Prerequisites Not Met Pre-Nursing Courses taken Application ADN Program Prerequisites Met Inquiry to ADN Program Inquiry to BSN Program Application To BSN Program Acceptance To BSN Program Acceptance To ADN Program ADN Employment In or Out of Nursing Interest in Nursing Employment In or Out of Nursing BSN Completion of Jr & Sr Year Nursing Curriculum Complete 2-year AND Curriculum NCLEX RN Licensure RN Licensure NCLEX Inputs

30 Pre-Nursing Courses & Nurse Aide I course Prerequisites Not Met Prerequisites Not Met Pre-Nursing Courses taken Application ADN Program Prerequisites Met Inquiry to ADN Program Inquiry to BSN Program Application To BSN Program Acceptance To BSN Program Acceptance To ADN Program ADN Employment In or Out of Nursing Interest in Nursing Employment In or Out of Nursing BSN Completion of Jr & Sr Year Nursing Curriculum Complete 2-year ADN Curriculum RN Licensure RN Licensure NCLEX NCLEX Throughputs

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

32 Preliminary Recommendation? The Task Force recommends that NC DPI work with NC s public and private higher educational institutions to assure that NC secondary schools offer and encourage students to explore health careers and prepare for these careers by taking appropriate coursework options that will assist them in meeting admission requirements at the time of high school graduation.

33 Preliminary Recommendation? Programs already in place via AHEC, the health science schools, the NC Center for Nursing and employers (e.g., Code Blue) to engage middle and high school students in programs to increase interest in health careers and prepare them for entry into programs of higher learning need to be strengthened and expanded.

34 Preliminary Recommendation? NC should create incentives (e.g., additional resources) to pursue national accreditation for all nursing education programs? All of NC s nursing educational programs should be nationally accredited by the year Note: May want to track these changes through either accreditation/licensure standards

35 Issues needing attention:? Pre-nursing interest stimulation programs? Readiness of applicants to meet prerequisites and admission requirements? Question: Are we arousing the interest of the right people?? Question: Are there potential qualified individuals with nursing interests who cannot access these programs?

36 Additional issues to consider:? Length of time required to complete pre-admission courses and prerequisites in Community College ADN programs?? Very little additional BON- approved capacity for enrollment expansion in Community College ADN programs.? What happens to the 52% who are accepted in ADN programs but who do not enroll?? What happens to the 8% of BSN applicants who are accepted but do not enroll?? It appears that there is 25% approved but unused capacity in BSN programs. Could this capacity be better utilized?? What are the alternative measures of nursing educational program capacity other than using the BON- approved slots.

37 Additional Issues to Consider? Possible re-alignment of BON approved slots with actual enrollment numbers? Possible proposal that BON no longer review and approve requests for expansion of enrollment in nursing educational programs? State-supported FTE student funding formulas in both public and private nursing educational programs? Procedures through which clinical training sites are identified and arranged by nursing educational programs

38 Additional issues to consider:? Are there types of nursing education programs that are more likely to help meet the need for specialized nursing personnel (e.g., school health, mental health, geriatrics, public health)?

39 So, we have a lot yet to do If we can just keep these balls in the air!

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