The need for Registered Nurses is expected to grow, and capacity of existing pre-licensure Baccalaureate of Science in Nursing (BSN) programs remains insufficient to meet the need for BSN - prepared nurses (American Association of Colleges of Nursing, 2017). Although recent trends demonstrate an upswing in nurses beginning practice with a BSN, nearly half of new nurses enter the profession through community college Associate’s Degree programs (Buerhaus, Auerback, & Staiger, 2016). Supporting and expanding traditional BSN programs remains an important mechanism to improve nursing educational levels, however the size of the nursing workforce and existing program capacity necessitate inclusion of other approaches.
Purpose: The proposed presentation offers an overview of existing and developing academic progression programs in nursing. We provide an overview of the underlying impetus for education transformation and identify key national leaders in the work. A primary objective is to identify commonalities among successful programs as promising practices for others.
Methods: Recognizing the need to provide additional pathways to the BSN and to improve inefficiencies in nursing education, the Robert Wood Johnson Foundation (RWJF) provided funding to explore and implement improvements via grants administered through the Academic Progression in Nursing (APIN) program and the State Implementation Program (SIP) (RWJF, 2012; RWJF, 2013). With support from the APIN and SIP National Program Offices, an ongoing collaboration of nursing education leaders, nursing employers, researchers and other stakeholders resulted in a deeper understanding of models for nursing academic progression. The group recognized early the critical role of employers and nursing practice partners and this was reinforced throughout the project. The Organization for Associate Degree Nursing provided early and ongoing support and was instrumental in advancing the work.
As work continued, members of the collaborative identified and addressed common concerns. They recognized the need to standardize program pre-requisites and co-requisites, although there was widespread objection to uniform curricula. Many education program leaders expressed concerns about the impact of innovative education models on accreditation. Rural partners had unique issues related to geographic isolation and limited resources. Each of these concerns was addressed through gatherings of key leaders and strategies for advancement. Throughout every aspect of the project, leaders identified the need for improved data collection and synthesis. Impact of the innovative models on student diversity was particularly difficult to assess. National experts on nursing workforce data and diversity provided critical consultation and guidance. The APIN leaders identified other education projects across the nation and included representatives from each in the growing collaborative. The APIN National Program Office summarized the iterative learning which resulted in their final report (Farmer, 2017).
Results: Of the programs studied, the model with the greatest likelihood of significantly impacting the proportion of nurses with a BSN or higher is intentional and structured partnerships between community college and university schools of nursing, which provide seamless or integrated pathways to the BSN. Partnership models embody many elements with the shared or common curriculum model described by the Center to Champion Nursing in America (CCNA) (Campaign for Action, 2013). CCNA and APIN leaders found that successful partnerships require consideration of many elements aside from nursing curriculum, and cataloging these elements allowed development of a continuum framework to describe programs.
Many schools of nursing indicate partnership are in place, but the absence of standardized definitions has led to complexities in sharing information and evaluating outcomes. In many cases, partnerships consist primarily of articulation agreements. These agreements are a useful starting point in strengthening academic progression and in many cases have eased student advancement, but they have not historically had the desired impact. Key features of successful programs included strengthening of relationships, effective leadership, plans for scaling and sustainability, and infrastructure such as messaging, academic advising, and student financial aid (Gerardi, 2015).
Leaders of this project found models in which students are co-enrolled in the community college and university to be the most successful to date, although many models have not been in place for a sufficient period to allow comprehensive assessment (Farmer, 2017). In most cases, co-enrollment models have been capacity -controlled and cannot fairly be compared to state articulation or transfer models, which incorporate all AD students into improved opportunities for progression.
Conclusion: Continued assessment and improved data collection are needed to evaluate the range of options available and identify the most effective and efficient methods of education progression in nursing. A number of approaches will likely be required to meet the needs of individual states and regions, but variations on partnership between community colleges and universities are showing the greatest promise. Highlighting promising practices may accelerate advancement nationally on this important initiative.