Nursing Education Strategy for Saskatchewan. Phase One Report: General Directions for Registered Nursing

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1 Nursing Education Strategy for Saskatchewan Submitted by: Saskatchewan Academic Health Sciences Network Submitted to: Saskatchewan Advanced Education, Employment and Labour i

2 EXECUTIVE SUMMARY A INTRODUCTION In light of their commitment to increase the number of nursing education seats in the province from 410 to between by 2011, the Government has requested that the Saskatchewan Academic Health Sciences Network (SAHSN) examine the current state of nursing education in the province and develop a provincial nursing education strategy for moving forward. Phase One of the project which is summarized below, focuses on the vision for Registered Nursing education in Saskatchewan and makes recommendations on program models that include both short term and long term directions. Phase Two of the project will consider the full array of nursing education programs. B CONCLUSIONS 1. NEPS has been successful in graduating RNs who are well regarded by employers in the province in providing nursing care to the citizens of Saskatchewan. 2. The future registered nursing education needs cannot be met through the current NEPS arrangements because of differing views of the two partners on matters pertaining to governance and program control. 3. NEPS administrative arrangements and inter-institutional relationships between the College of Nursing, University of Saskatchewan (U of S) and the Nursing Division, Saskatchewan Institute of Applied Science and Technology (SIAST) are severely strained to the point that there is no longer a willingness to work together in a manner that will meet the aspirations of both parties. 4. Attempts to restore NEPS at this point would create serious disruptions and impair the capacity to increase nursing enrolment. 5. More flexibility in program structure, curriculum and clinical placements are required to address several current issues including the needs of First Nations/aboriginal students and First Nations/aboriginal communities. ii

3 6. The expansion of a nursing education program will require strategic preparation and supply of nurse educators and an assessment of physical space requirements. C RECOMMENDATIONS 1. A two-provider model for RN nursing education in Saskatchewan should be adopted. 2. The U of S should implement its new program with an enrolment intake of up to 350 students. 3. SIAST should continue to have a role in RN nursing education leading to a baccalaureate degree (not applied degree) with a program intake of up to 350 students. 4. SIAST should not have degree granting status for nursing education until the Government establishes a provincial post-secondary strategy with the requisite provincial and institutional policy framework and infrastructure for baccalaureate education in non-university post-secondary institutions. SIAST does not have all the policy and infrastructure in place to support baccalaureate level education at this time. 5. A University should be identified to develop a collaborative nursing education program with SIAST building on SIAST s experience, expertise and resources. This collaborative program would serve as the second provider of RN nursing education in Saskatchewan. 6. First Nations University of Canada (FNUniv) should be encouraged to work with either or both RN nursing education providers. 7. U of S should build on its proposal to develop an inter-professional first year and over time move to a non-direct/second entry program model. This would differentiate the program from the University/SIAST collaborative program which would be direct entry. 8. U of S should place increasing emphasis on the development of its graduate programs to prepare nursing faculty and support advanced practice and leadership roles. 9. SIAST should build on its experience and continue to develop its specialty programs in nursing: the College of Nursing should limit its Continuing Nursing iii

4 Education programs to areas that are consistent with its mandate to provide undergraduate and graduate education and university level continuing education. 10. The current Second Degree Entry Option (SDEO) should be restructured and totally provided within the U of S as this is in keeping with the direction of the recommendation that the university focus on second entry to nursing. 11. Both programs should be run as distributed models throughout the Province with no geographic limitations to either and both programs should develop increased partnerships with other post-secondary institutions, health organizations and community agencies. D NEXT STEPS A comprehensive transition and communication strategy will be required that considers the complexity of the plan and the impact on key stakeholders and the citizens of the province. Accordingly, a task group will be required to oversee a smooth transition from the NEPS to the new nursing education model and ensure that all stakeholders are informed of major developments during this stage. iv

5 TABLE OF CONTENTS EXECUTIVE SUMMARY 1. Introduction Scope of the Project Approach and Methodology This Report 4 2. Overview of Nursing Education Historical Context of RN Education in Saskatchewan The Nursing Education Program of Saskatchewan NEPS Delivery SRNA Program Approval Government s commitment to nursing education 9 3. Challenges Ahead Current strengths of existing program Weaknesses of the current program Opportunities Threats Emerging Models of Nursing Education College-University Transfer Models College-University Collaboration Best Practices in Collaboration College-University Collaborative Program Models Other Program Models The NEPS Proposed Models of Nursing Education Proposed U of S Model for Nurse Education Proposed SIAST Model for Nurse Education Nursing Education Strategy Conclusions and Observations Critical Considerations Recommendations Transition Strategies Context Communication Strategy 29 APPENDICES A Terms of Reference B Expert credentials C Literature Review D Committee membership lists v

6 1. Introduction Registered Nurses (RNs) comprise the largest group of health professionals in Saskatchewan and play a unique role in the delivery of health care to the citizens of the province. The nursing shortage has put a serious strain on the health system. Simply put, if nothing changes, there are not enough nurses to meet the requirements of the health care system today, and there are far too few nurses to meet the needs of the future. Nursing education plays a critical role in the solution. The Government of Saskatchewan has taken some significant steps to cope with the nursing shortage. Consistent with that, they have requested that the Saskatchewan Academic Health Sciences Network (SAHSN) examine the current state of nursing education in the province and develop a provincial nursing education strategy for moving forward. A compelling rationale for this timely review of nursing education is the government s ambitious intention to increase the number of nursing education seats in the province from 410 to between by The development and implementation of the vision for an overall nursing education strategy will require both interim and long term directions. The issues associated with nursing education are complex and dynamic. They also involve multiple stakeholders including: government, employers, professional regulatory bodies, accreditation agencies, unions, nursing students, educators and the nursing groups themselves - Registered Nurses (RNs), Registered Psychiatric Nurses (RPNs) and Licensed Practical Nurses (LPNs). A successful strategy will require a careful balance of the needs of these interdependent relationships among the health service providers. In the spirit of collaboration and in the public interest, stakeholders will need to work together to strengthen our nursing education systems which will ultimately enhance the quality of health care in Saskatchewan.

7 This Phase One report of the review of nursing education in Saskatchewan focuses on the vision for RN education in Saskatchewan and makes recommendations on program models that include both short term and long term directions. It will serve as the underpinning of the broader Phase Two report. 1.1 Scope of the Project The purpose of the project is to provide direction for an overall Nursing Education Strategy for Saskatchewan. The broad scope of the project will consider the full array of nursing educational programs for Continuing Care Assistants (CCA), Licensed Practical Nurses (LPN), Registered Nurses (RN), Registered Psychiatric Nurses (RPN), Nurse Practitioners (NP) and Masters and PhD level education in nursing. The target audience for the reports is the Government of Saskatchewan where the ultimate responsibility lies to develop and implement a Nursing Education Strategy for the province. The full terms of reference for the project are attached as Appendix A. 1. The Phase One report will focus on the vision for education at the RN level and make recommendations on the program model. 2. The Phase Two report will identify the key issues and considerations for the overall vision of nursing education including implications from the Phase One report and provide both directions and areas that require further work. Both phases of the review are to provide strategies to address the following questions: 1. How can the skills and knowledge expectations of nursing personnel in a variety of work environments and the emerging needs in nursing practice be best developed within the educational programs in collaboration with professional associations and employers in Saskatchewan? 2. How can nursing education programs lead in the adoption of quality educational practices and best contribute to overall societal needs through 2

8 research, intra-professional and inter-professional practice and community engagement in Saskatchewan? 3. What would be the most effective and timely nursing education initiatives to meet the nursing supply needs of the Province? 4. How can laddering and/or bridging opportunities be further developed to facilitate the progression of individuals to higher levels of nursing education, including a wider range of options to recognize prior formal and informal learning? 5. How can nursing leadership needs, including faculty requirements to ensure the sustainability and growth of nursing education programs, be addressed? 6. How can nursing education programs best contribute to the achievement of overall health system directions? 1.2 Approach and Methodology Given the complexity and significance of the project, several approaches and methodologies were used to ensure a comprehensive analysis. The Nursing Education Strategy project was managed by the Project Coordinator, Don Philippon, PhD who is the Special Advisor to the SAHSN. 1. An inclusive Project Advisory Committee was created to guide the overall project. 2. In addition, a Phase One RN Subcommittee, a subset of the larger Project Advisory Committee was created to allow for a concerted focus on the model for RN Education in the province. 3. Two external advisors, Gail Donner, RN, PhD and Mary Ellen Purkis, RN, PhD were engaged to provide perspective on the strategic development process. Expert credentials are included as Appendix B. 4. A comprehensive literature review was undertaken by Dale Kirby, PhD to provide a foundation for the recommendations (attached as Appendix C). 3

9 5. Focus groups will be conducted as part of the Phase Two research. Membership of the Project Advisory Committee and the RN Subcommittee are attached as Appendix D. 1.3 This Report This report captures the Phase One deliberations on the vision for RN education in Saskatchewan and makes recommendations on the program models that include both short term and long term directions. Following this introductory section, Section 2 of the report will provide a snapshot of registered nursing education in the province today, section 3 will provide a brief assessment of strengths, weaknesses, opportunities and threats of the existing system, section 4 will assess current and emerging nursing education models, section 5 will outline the proposed SIAST and U of S nursing education models and section 6 will provide options and recommendations for a provincial RN education strategy and will discuss the need for a transition and communication strategy. 4

10 2. Overview of Nursing Education 1 As a result of changes in the health needs of Canadians and the growing complexity of the health care system, nursing education in Canada has undergone significant changes since the 1980s. In response to calls for fundamental changes in the delivery of basic nursing education, in 1982, the Canadian Nurses Association (CNA) unanimously endorsed the baccalaureate degree as the minimum entry-to-practice educational requirement for all new nurses seeking registration as RNs by the year Most provinces have now mandated baccalaureate programs as the RN entry-to-practice requirement. The rationale for nurses with university-level preparation stems from the challenges of an increasingly complex health care system and the expansion of knowledge and knowledge requirements of nurses for engagement in high quality care. These services will involve increasingly intensive intervention within the acute care sector and will demand responsive and autonomous practice within the community care sector. Canada is confronted not only with the need for baccalaureate educated registered nurses but also for significantly more registered nurses in the health system in response to the nursing shortage. 2.1 Historical Context of RN Education in Saskatchewan By the 1980s, nursing students in Saskatchewan had the option of completing either a diploma program through an institute or a university degree program. The SRNA formally endorsed the baccalaureate entry-to-practice position in In 2000 the SRNA, the deans of nursing at SIAST and U of S and the Government of Saskatchewan jointly agreed to a Memorandum of Understanding (MOU) which recognized the baccalaureate degree as the minimum entry-to- 1 Dale Kirby s literature review (attached as Appendix C) was used throughout sections 2.1 to 2.4 inclusive. 5

11 practice education requirement for licensure as an RN in Saskatchewan. This MOU also outlined the educational strategies that would be pursued in order to provide an adequate supply of baccalaureate-prepared nurses. These strategies included: 1. Enhanced distance education opportunities, 2. Expanded degree completion options, and 3. Increased nursing education opportunities for Aboriginal students. 2.2 The Nursing Education Program of Saskatchewan The Nursing Division of SIAST and the College of Nursing at the U of S formed a collaborative partnership in 1996 to jointly provide the Nursing Education Program of Saskatchewan (NEPS). The four-year program leads to a Bachelor of Science degree in Nursing which is conferred by the U of S. The first students were admitted to the program in September 1996 and first graduates convocated in the spring of The First Nations University of Canada (FNUniv) joined the partnership in March Part-time study is an option with the proviso that all courses be completed within seven years of commencing the program. Graduates of the four year program may apply for licensure with the Saskatchewan Registered Nurses' Association (SRNA). NEPS has served the profession and the health care system well and has graduated thousands of nurses. It is designed to prepare graduates with the knowledge, skills and judgment necessary for professional nursing practice in a variety of health care settings. The program boasts a high percentage of nursing students passing the Canadian Registered Nurse Examination (CRNE) the pass rate for first-time Saskatchewan writers for the 2007 CRNE was over 96 % - a level that is above the national average. The program also graduates the highest percentage of aboriginal students in the country. 6

12 2.3 NEPS Delivery Nursing Education Strategy for Saskatchewan NEPS is delivered from Saskatoon, Regina and Prince Albert sites. Those admitted to the program are students of both SIAST or FNUC and the U of S. 1. In Saskatoon, students take courses at the SIAST Kelsey Campus for the first two years of the program and the U of S for the years three and four. 2. In Regina, nursing courses are held at the SIAST Wascana Campus and non-nursing courses are accessed at the University of Regina. 3. In Prince Albert, all nursing courses are held at the Northern Campus of FNUC. Non-nursing courses are accessed at the FNUC. Clinical practice takes place at various locations throughout the province. The U of S and SIAST also offer the NEPS Second Degree Entry Option (SDEO) implemented in 2005, to recognize previous university achievements of qualified students and provide them with the opportunity to receive a degree in a shortened time period. The SDEO is available to students who have completed a baccalaureate degree, or have made significant progress toward a degree in another field. The option provides an opportunity for full-time intensive study with program completion in two years. The first graduates of the SDEO convocated in the spring of The U of S College of Nursing also offers a program leading to the Master of Nursing degree and there is a proposal currently under review for a PhD program. Combined student enrolment in the NEPS SDEO and NEPS at Prince Albert, Regina and Saskatoon has been increasing since the programs were implemented. A further increase in enrolment is planned for academic year. Table 1 below provides a breakdown of NEPS student intakes for and

13 Table 1 - NEPS Stream Prince Albert Regina Saskatoon SDEO Total SRNA Program Approval As the self-regulatory body governing the profession under the Saskatchewan Registered Nurses Act, 1988, the SRNA has been delegated the regulatory authority to set the basic educational requirements for the province s RNs. The SRNA Nursing Education Approval Committee has granted five-year program approvals to the NEPS in 1996, 2001 and These approvals are subject to the SRNA s annual evaluation of progress made toward recommendations outlined in the committee s report. A determination of whether the substance of each recommendation has been met will be assessed annually from NEPS reports that are to be submitted to the SRNA. Working in conjunction with the professional regulatory bodies, the Canadian Association of Schools of Nursing (CASN) is the official voluntary accrediting agency for baccalaureate-level nursing education programs in Canada. 8

14 2.5 Government s commitment to nursing education The Saskatchewan government acknowledges a critical shortage of RNs and has committed to graduate as many as 800 nursing students a year by In order to achieve this substantial goal, as many as 300 new nursing education seats are required in the province. The Ministry of Advanced Education, Employment and Labour has outlined several key indicators of success for a model of nursing education from the perspective of the learner and the system. With respect to the learner, accessibility is a key factor; opportunities such as bridging and seamless transitioning from the various levels in the profession will be critical to the success of a new model. Targeted access must be maintained for key groups in order for government to fulfill its legislative commitments. Distance education, increased opportunity for nursing students in the rural/remote areas and portability issues between provincial institutions must also be considered. Research advancement and enhanced skill development in areas of specialty, such as gerontology and cardiac care, must be designed to meet the needs of learners who want to improve their skills or to better serve the needs of their communities. Affordability for the learner in terms of both tuition costs and living costs are other metrics that could be used to assess the strength of a nursing model. Another key indicator for government of a successful program is the rate of retention of graduates in the Saskatchewan health care system. The expansion of human and capital resources to enable increased nursing student enrollment, will require accountability for these investments and a clearly articulated evaluation framework. Consistent with that, there is also a need for system for measuring outcomes related to the impact of these investments on government, employers, students, faculty and other stakeholders. Ultimately, measuring outcomes will ascertain how well the nursing needs of the citizens of Saskatchewan are being met. 9

15 3. Challenges Ahead Nursing Education Strategy for Saskatchewan A great deal has been accomplished in the past twelve years in relation to nursing education. New initiatives have been developed and nurtured with multistakeholder cooperation and in recognition that the problem of ensuring a continuing supply of nursing human resources is a significant provincial concern. There is much work to be done, however, to ensure that the citizens of Saskatchewan have access to a sustainable source of quality nursing care. Government asked the SAHSN to develop a comprehensive process which included submissions and dialogue with stakeholders, a literature review conducted by Dale Kirby, PhD and the opinion of external experts Gail Donner, RN, PhD and Mary Ellen Purkis, RN, PhD. There is a need for a timely and detailed strategic planning process to develop a clear vision and direction for nursing education that is consistent with the needs of the citizens of Saskatchewan. Relevant models for nursing education must focus on proactive solutions to those needs. The following summarizes the strengths, weakness, opportunities and threats as described by stakeholders. 3.1 Current strengths of existing program Nursing education is delivered in three major centres in the province; Prince Albert, Saskatoon and Regina. This arrangement should be continued and expanded where possible, allowing for increased accessibility. Nursing education is based on the primary health care model, a forward looking approach that will serve the province well the future. Passing rates for graduates on Canadian Registered Nurse Exams is above the national average. 10

16 FNUniv entry into nursing education has meant increased sensitivity to Aboriginal issues. The NEPS has the highest aboriginal participation rate among nursing education programs in the country. Despite the different cultures of the institutions in the NEPS, faculty have supported the educational needs of students with professionalism. 3.2 Weaknesses of the current program Due to philosophical differences in the current NEPS, there is concern about the program s ability to graduate enough nurses to meet the increased needs of the province. Lack of faculty capacity and physical space capacity are critical issues. The unique needs of Aboriginal communities in relation to educational access for community members and student access for practice experience are inadequately addressed within the current collaborative model. Aboriginal students are double and sometimes triple counted by other institutions. Differences in policies and cultures among the institutions, has lead to confusion for students and faculty. Representatives from both institutions indicated that students are unclear about affiliations and different institutional practices which present challenges as they move between two institutions; examples cited relate to registration and the move from 2 nd to 3 rd year in the NEPS. Different labour contracts between faculty at SIAST and the U of S has lead to different expectations on the issue of faculty workload, responsibility and activities i.e. the place of research vs teaching. SDEO students run into confusion as to what institution they deal with in terms of getting services they require. 11

17 Inter-professional opportunities are limited and those available are not accessed to the full extent. Also opportunities are limited by what year a student is in. There has not been a strong take-up of graduate nursing education at the masters or doctorate level. According to the Canadian Institute for Health Information (CIHI) nursing data base, 1.6% of Saskatchewan RNs have masters or doctorate level education compared to 2.7% nationally. Nursing Education is delivered primarily in three centres: Prince Albert, Saskatoon and Regina. This can make living expenses for students from rural and Northern areas cost prohibitive. 3.3 Opportunities Partners share a common goal of the importance enhancing distributive learning opportunities particularly for rural and northern areas. The use of technology to enhance off campus learning opportunities has significant potential. SIAST currently has six courses offered through Distance Education under the NEPS and the U of S has recently added an IT support person to enhance and expand their distributive learning programming. Government policy to increase the number of nursing seats in the province is an opportunity to take leadership and to move RN educational models to be more forward thinking. There is an opportunity to put in place structures that will allow the advancement of nursing research and scholarly work particularly at the U of S. There is a need to enhance clinically focused rural, Aboriginal, mental health and gerontology. New models can add to the critical mass of aboriginal nursing students and be more flexible in adding aboriginal elements to clinical practice and curriculum. 12

18 New models can allow for partnering with other organizations to develop a more distributed model for RN education. 3.4 Threats U of S has developed a plan to respond to opportunities to expand interprofessional education as part of a major curriculum review of the nursing program. Because such changes cannot be accommodated within the existing collaborative arrangement, the University has indicated that it wishes to withdraw from the NEPS. This decision puts significant pressure on SIAST which does not currently have a mandate to grant degrees. The province is facing significant challenges in relation to its current capacity of educational institutions to prepare increased numbers of nurses for the future needs of the health system. There is a critical shortage of qualified teaching staff for the immediate demands related to the planned expansion in RN education and this will become more acute unless the U of S can place a greater emphasis on graduate programs. There is a critical need for capital expansion to support growth in RN education capacity. If changes are to be made to the current RN education model, those changes will have to be implemented without causing significant disruptions to the flow of qualified nurses into the heath system. 13

19 4. Emerging Models of Nursing Education 2 This section provides a brief overview and analysis of the various structures of baccalaureate nursing education programs with a focus on college-university collaborative nursing programs. 4.1 College-University Transfer Models Under the credit transfer model, students can receive program credit when transferring from one post-secondary institution to another regardless of the types of institutions involved. 1. Under the course-by-course transfer model, individual courses completed by students at a community college are recognized as equivalent to individual courses at a university. 2. The multiple course transfer model is advantageous when course-bycourse credit transfer is not possible because, for example, the course content at the community college level does not include the same competencies included in courses at the university level. 3. Inter-institutional transfer arrangements that follow the block transfer model recognize a certificate program, diploma program or some block of courses completed at a community college and allow students to transfer directly into the second or third year of a university baccalaureate degree program. 4. Like the block transfer model, the program bridging model allows students to receive advanced standing in a baccalaureate degree program at the receiving university in recognition of a certificate program, diploma program or some block of courses previously completed at the community college-level. 2 Dale Kirby s literature review was used throughout this section. The comprehensive literature review is contained as Appendix C. 14

20 4.2 College-University Collaboration Like the credit transfer program models, collaborative college-university programs are jointly planned and offered by community college and university partners and involve formalized inter-institutional articulation agreements. Collaborative programs are also jointly delivered by qualified college and university faculty members at one or more sites and, upon completion of the program, graduates receive a baccalaureate degree that is conferred by the university partner. Compared to credit transfer models, however, collaborative programs are characterized by joint governance models and a more seamless transfer of students. The admission requirements, duration and curriculum of collaborative programs are the same or similar for all students in the program, and collaborative programs in their entirety must meet the same accreditation and approval requirements as stand-alone university programs. Colleges and universities involved in collaborative programs may choose to share library resources and purchasing powers; jointly develop distance education resources; and combine research capacity. Depending on the collaborative program model, faculty may teach only at one site or they may teach at multiple sites. 4.3 Best Practices in Collaboration While many programs have developed collaborative arrangements across college-university boundaries, nursing education programs in Canada have been perhaps the one discipline most involved in the development of these sorts of arrangements. Collaborations were created as a practical means to take best advantage of the existing infrastructure in both the university and college programs as the baccalaureate degree became the standard entry qualification for professional nursing. Collaborative models meant that the different mandates of colleges and universities would not impede the production of a steady and, indeed, expanding number (CIHI, 2007) of RNs for the health care system. As a practical strategy, rarely were the full implications of such a widely implemented 15

21 project considered. A consistent, recurring theme in the extensive research literature on collaboration is that institutional cooperation of any sort, regardless of the model, requires significant and sustained effort. Aside from working together with goodwill, commitment, flexibility and creativity, there are a number of important practices that assist colleges and universities in working together to develop collaborative arrangements. These best practices can help address the specific requirements of all partners while avoiding commonly experienced barriers that complicate collaborative efforts. 1. Partner Relations and Communication - Models of inter-organizational collaboration emphasize relationships and informal negotiation processes among individuals/groups as more important than formal processes and central to moving organizational collaborations forward. 2. Partnership Agreements - Formal agreements or memoranda of understanding that formalize the structure of relations between institutions commonly establish joint committees for decision making, outline academic policies and procedures, clarify protocols for sharing human resources and facilities, and ensure the equitable distribution of program funding. 3. Program Governance - To implement and operate effective collaborations, college and university partners must overcome differing approaches to governance that stem from sectoral differences in program culture and organization. To address the governance and administrative issues, interinstitutional committees should be established with agreed upon operating procedures relating to committee membership, the mode of selecting committee members and committee chairs, terms of office, and decisionmaking protocols. Operating these sorts of governance processes over the long-term requires the dedication of considerable resource to support collaborative planning, decision-making and implementation. Senior educational leaders often raise questions about the need for this level of on-going investment of limited public funds. 16

22 4. Administrative Processes - When a number of institutions come together in collaboration they frequently bring differing standards, rules and criteria that are applicable to the administration and delivery of the collaborative program. These include program registration and admission requirements, policies on maintaining and accessing student records, tuition and ancillary fee policies and faculty employment contracts. 5. Collaborative Program Faculty - Faculty support and opportunities for faculty development have been shown to be highly influential to the success of collaborative baccalaureate nursing programs. 6. Student Supports and Resources - Students often experience adjustment problems in making the transition to postsecondary education from high school. However, like students in transfer programs, students enrolled in collaborative programs can face added levels of stress and difficulty in negotiating a program of study that is offered by more than one unfamiliar institution. It is important that these students have equal access to transparent academic appeal policies and clarity with regard to expectations on matters of student behaviour. 4.4 College-University Collaborative Program Models A comprehensive list of potential collaborative models is outlined in Appendix C. The models include: 1. Integrated Model - In programs that follow an integrated program model, both the college and university partners are involved in each year of the program from the beginning, with different instructional activities provided by each institution. All students in a cohort proceed through the program together. 2. Articulated Model - Under the articulated program model, the first part of the program, usually the first two years, are delivered by the college 17

23 partner (2+2 model). Following the initial two years, students transfer to the university site and complete the remaining two years. 3. Parallel Model - For programs that follow the parallel model, cohorts of students separately begin their programs at the college and university site. Students stay at the same site through all four years of the program and complete a common agreed curriculum. 4. Sandwich Model - The sandwich model involves student access to two or more educational institutions for completion of the four-year degree program. The first and final years of the program are taken at the university site and the middle two years (the sandwich ) are delivered by the community college partner site(s). 5. Hybrid Model: Articulated-Parallel Model - In the articulated-parallel model, students can complete the first two program years at a college partner site and transfer to the university site following year two. However, in addition to the articulated program component, the university also enrolls students in the first two program years. 6. Hybrid Model: Partially-Integrated Model - As the name suggests, in partially-integrated models some years, semesters or classes of the program are integrated. While, for the most part, these programs operate like the parallel or articulated models, some program components are jointly delivered and there is a crossover of students and faculty between sites. 4.5 Other Program Models Aside from the transfer and collaborative program models the non-collaborative possibilities include the community college baccalaureate degree and the university-directed or managed model in which the university delivers the entire program using resources (human, material, space) provided by the college. 18

24 4.6 The NEPS While NEPS was originally intended to follow an integrated program model, the delivery model that has evolved since its introduction is not characteristic of the integrated model. The NEPS model is uniquely structured at each of the three program sites, making it difficult to generalize across the entire program. For the most part, the program most closely resembles the articulated program model with one partner (SIAST or FNUniv) offering years one and two and the U of S offering years three and four. While characteristics of the articulated model dominate, the program also appears to have some partially integrated characteristics. 19

25 5. Proposed Models of Nursing Education Both the U of S and SIAST have developed proposals for preferred nursing education options for the province. The strength and weaknesses of each are outlined below. 5.1 Proposed U of S Model for Nurse Education The U of S intends to develop a new three year BSN in Saskatoon preceded by a common inter-professional first year. The program would run independently of SIAST and enable the College of Nursing to enhance its commitment to, and capacity to deliver inter-professional education to its students by taking advantage of other programs offered such as Medicine, Physiotherapy and Pharmacy programs. This environment, the U of S argues, can improve the quality of the learning experience. The strengths of U of S Proposed Model include: The U of S model incorporates an inter-professional component in their nursing education model. It can increase its commitment to distributive learning and clinical practice experiences. Student identity and culture can be better enhanced if students are educated within the university environment from the outset of their program. Provincial needs for increased master level and PhD educated RNs would get more emphasis. 20

26 Weaknesses with the U of S model are: The common, year-one Inter-professional year has not yet been implemented and still requires approval and acceptance throughout the university as a standard for health care education. The compressed timeframe for implementation of the U of S proposed model leaves concerns about the U of S s ability to deliver the numbers of nursing graduates that the Province has specified it requires. The claim that the University could deliver on the provincial commitment for nearly 800 nurses graduating each year does not seem realistic or even desirable. Having the U of S as the sole provider of RN nursing graduates at an enrolment intake level of students per year would jeopardize the university s ability to meet its mandate in nursing research and for graduate level education as these priorities would have to become secondary to meeting the province s need for more RNs in the health system. 5.2 Proposed SIAST Model for Nurse Education SIAST s preferred direction is to attain degree granting status and deliver the current NEPS on its own. SIAST foresees their program accommodating 350 students with no proposed increase to the current funding levels except for those already planned. The strengths of the proposed model are: It can build on its continued commitment to the distributive learning model. The current focus of this distribution is in the Regina area where population levels would support a second program (distinct from the U of S). 21

27 The NEPS faculty at SIAST would continue to be fully and actively employed in the preparation of RNs. With a second program offered, students have a choice to select the program that serves their education and career choices best. Weaknesses of the SIAST model include: Any proposal for degree granting status for SIAST must be part of a comprehensive province-wide, post-secondary education policy and nursing education strategy and not as a result of a direct response to the current challenges to the nursing education environment. SIAST lacks the infrastructure required to grant degrees in nursing particularly with regards to research capacity, research development, a collective agreement congruent with degree granting and the opportunity for faculty to work collaboratively with other degree based professional programs. The proposed timelines for the project may prove unrealistic given the breadth of the proposed model. It may be challenging to find enough qualified faculty to ensure the program maintains high standards. 22

28 6. Nursing Education Strategy This section outlines the conclusions, observations, major considerations and recommendations for a future focused nursing education strategy. The following options were considered: 1. NEPS as currently structured is retained. 2. U of S becomes the sole provider of nursing education in the province using a distributed and contracting model. 3. A two-provider nursing education model is developed and implemented involving the U of S and a second Baccalaureate Degree granting institution (SIAST as Degree Granting or a University SIAST collaborative program). FNUniv would partner with either or both. 6.1 Conclusions and Observations The following summarizes the key findings from the research and consultations conducted over the past two months. 1. NEPS has been successful in graduating RNs who are well regarded by employers in the province in providing nursing care to the citizens of Saskatchewan. 2. While the NEPS structure has served the province well for the last decade, serious structural issues have emerged which require a new model to meet future registered nursing education needs. These issues can be summarized as follows: a. The current model for program governance does not permit the U of S to exercise academic control consistent with University expectations around the awarding of the baccalaureate degree. b. The College of Nursing plans to move to a new curriculum with a key feature being the introduction of a common inter-professional 23

29 year for all health science students. This would not be possible within the current arrangement. c. Curriculum change under NEPS is cumbersome. 3. NEPS administrative arrangements and inter-institutional relationships between the College of Nursing, U of S and the Nursing Division, SIAST are severely strained and there is no longer a willingness to work together in a manner that will meet the aspirations of both parties. However, there is a commitment and willingness by both parties to continue to work together to allow the students enrolled in NEPS (including a cohort entering in 2008 and 2009) to complete their program. This will be critical to the success of NEPS until at least 2013 and possibly longer. This transition period will allow both parties to restructure their programs. 4. Attempts to restore NEPS as the platform upon which to build future RN education needs would likely create serious disruptions and impair the capacity to increase nursing enrolment as the two major parties have very different philosophies on how to structure registered nursing education. While the commitment to work together in the short term exists, this cannot be interpreted as a willingness to work together in the longer term unless fundamental changes in NEPS are made. Such changes would dismantle NEPS as it is currently known. Accordingly, to expect the College of Nursing and SIAST to develop a long term solution within the NEPS framework would lead to serious delays in being able to make decisions on staffing and infrastructure that are critical to meeting the enrolment expectations set by Government. 5. More flexibility in program structure, curriculum and clinical placements are required to address several current issues including the needs of First Nations/aboriginal students and First Nations/aboriginal communities. 6. The expansion of a nursing education program will require strategic preparation and supply of nurse educators and an assessment of physical space requirements. 24

30 6.2 Critical Considerations Nursing Education Strategy for Saskatchewan The following are key considerations that will be pivotal to the success of the implementation strategy for the nursing strategy. There is some urgency to moving forward in a timely, responsive and accountable manner. Any new RN education model must ensure that the current approvals for nursing enrolment increase be met. Any new model must recognize the need to further increase nursing enrolment capacity. Building capacity will require immediate attention to increased faculty recruitment and to physical space needs. Implementation of a new RN education model must balance potential disruption in program capacity in the short term with setting a direction that builds and sustains quality RN nursing education in Saskatchewan for the longer term. A new RN model must recognize the need to for a major nursing education presence in the two larger health regions (Regina and Saskatoon) and be robust enough to enable an enhanced distributed approach for nursing education throughout the entire province. All RN nursing education should be equivalent in terms of the acceptance of graduates into higher levels of education. A new RN education model should allow for increased flexibility for qualified graduates of other programs to transition into RN education programs and for RN graduates to move into other programs. Any new model should allow for increased flexibility to partner with other educational institutions that may be able to assist in providing a more distributed model of nursing education in the province. Through collaborative partnerships, there will need to be a balance between potential disruptions to increase the number of nursing graduates 25

31 required with the need to offer the best quality of nursing education. Specifically, the model must mitigate disruptions to potential nursing students and the health system, for example the partners in nursing education such as the clinical agencies. A new model of RN education must emphasize the importance of coordination among the educational institutions offering nursing education programs and strong partnerships with health regions and other clinical and community agencies involved in the delivery of the programs. 6.3 Recommendations 1. A two-provider model for RN nursing education in Saskatchewan should be adopted. 2. The U of S should implement its new program with an enrolment intake of up to 350 students. 3. SIAST should continue to have a role in RN nursing education leading to a baccalaureate degree (not applied degree) with a program intake of up to 350 students. 4. SIAST should not have degree granting status for nursing education until the Government establishes a provincial post-secondary strategy with the requisite provincial and institutional policy framework and infrastructure for baccalaureate education in non-university postsecondary institutions. SIAST does not have all the policy and infrastructure in place to support baccalaureate level education at this time. 5. A University should be identified to develop a collaborative nursing education program with SIAST building on SIAST s experience, expertise and resources. This collaborative program would serve as the second provider of RN nursing education in Saskatchewan. 6. FNUniv should be encouraged to work with either or both RN nursing education providers. 26

32 7. U of S should build on its proposal to develop an inter-professional first year and over time move to a non-direct/second entry program model. This would differentiate the program from the University/SIAST collaborative program which would be direct entry. 8. U of S should place increasing emphasis on the development of its graduate programs to prepare nursing faculty and support advanced practice and leadership roles. 9. SIAST should build on its experience and continue to develop its specialty programs in nursing and the U of S should limit its Continuing Nursing Education programs to areas that are consistent with its mandate to provide undergraduate and graduate education and university level continuing education. 10. The current Second Degree Entry Option (SDEO) should be restructured and totally provided within the U of S as this is in keeping with the direction of the recommendation that the university focus on second entry to nursing. 11. Both programs should be run as distributed models throughout the province with no geographic limitations to either. Both programs should also develop increased partnerships with other post-secondary institutions, health organizations and community agencies. 6.4 Transition Strategies Context It will be important to move ahead and maintain the momentum with a model for RN nursing education that both allows for enrolment increases and for continued stability in the program. 27

33 Considerations for a transition strategy A transition strategy is required to allow the configuration of a two-provider model to be determined at the government level. The following are considerations for a transition strategy: 1. SIAST intends to pursue nursing degree granting status with government with a view to achieving this by 2010 so that it can become the second provider of RN nursing education in the province. Accordingly, SIAST is not inclined to seek another University partner. 2. The government process to review the SIAST degree granting request will take some time and cannot be achieved until a policy direction has been articulated and legislative changes are made. 3. The U of S plans to move ahead with introducing its new program in September The last cohort of NEPS students would commence in September 2009 and would not complete until 2013 at the earliest. 5. Moving to a two-provider model has the potential to cause disruption in the flow of RNs into the health system because it is not clear whether and when SIAST will become a degree granting institution. 6. If SIAST does not get degree granting status, then the only other real alternative to achieve a two-provider model is for the University of Regina (U of R) to develop a Nursing program building on expertise at SIAST. 7. The SRNA has stated they will need to have full program proposals by June 2009 in order to have time to evaluate and grant approval for September