- Email: [email protected]
Regionally Increasing Baccalaureate-Prepared Nurses: Development of the RIBN Model
REGIONALLY INCREASING BACCALAUREATE-PREPARED NURSES: DEVELOPMENT OF THE RIBN MODEL VINCENT P. HALL, PHD, RN, CNE,⁎ BRENDA CAUSEY, MSN, RN,† MARY bPOLLYQ JOHNSON, MSN, RN, FAAN,‡ AND PAT HAYES, MSN, RN, NEA-BC§ The nursing shortage remains an acute problem at the national level and significantly endangers the provision of safe and effective health care. One of the most significant problems fueling the nursing shortage in the United States is the lack of faculty to educate the number of qualified individuals applying to nursing programs. A major factor driving the shortage of faculty emanates from the current trend in basic nursing education that is increasing the proportion of nurses with an associate degree in nursing (ADN) as their terminal professional education. Community colleges, that offer the associate degree, play a crucial role in providing access to nursing education. However, they now account for more than 2/3 of all new nursing graduates in the United States. With over 2/3 of our new nurses completing only associate degree programs, the faculty pipeline continues to decrease. This also means fewer bachelor of science in nursing (BSN) and higher-degree-prepared nurses available for advanced clinical practice, management roles, and public health services. It is therefore critical to identify and implement new pathways to increase the number of ADN graduates who complete baccalaureate education and, thereby, increase the percentage of BSN-prepared nurses. This article describes the development and implementation of a model in North Carolina to regionally increase the number of baccalaureate-prepared nurses through the development of partnerships between community colleges and universities. (Index words: Nursing shortage; Nursing faculty shortage; Associate degree nursing; Baccalaureate degree nursing) J Prof Nurs 28:377–380, 2012. © 2012 Elsevier Inc. All rights reserved.
T
HE STATE OF the nursing shortage in the United States has changed somewhat and is not currently as bleak as predicted. There are several factors that serve as indicators for this change, and they include the following: (a) the economic recession that has forced experienced nurses to return or remain in the workforce (Dolan, 2011), (b) the continued growth of the health care sector, unlike other major industries in the United States (Bureau of Labor Statistics, 2012), and (c) the increase in the number of young registered nurses (RNs; aged 23–
∗Director, School of Nursing, Western Carolina University, Cullowhee, NC. †Chair, Department of Nursing, Asheville-Buncombe Technical Community College, Asheville, NC. ‡Executive Director, Foundation for Nursing Excellence, Raleigh, NC. §Asheville, NC 28803. Address correspondence to Dr. Hall: Director, School of Nursing, Western Carolina University, Cullowhee, 19 Town Square Blvd., Apt. 206, Asheville, NC 28803. E-mail: [email protected] 8755-7223/12/$ - see front matter
26 years), measured as full-time equivalent RNs, that has increased by 62% between 2002 and 2009 (Auerbach, Buerhaus, & Staiger, 2011). However, in spite of these factors, the nursing shortage remains an acute problem at the national level (Olshansky, 2010) and significantly endangers the provision of safe and effective health care. Further, despite the current easing of the shortage because of the recession and other factors, the nursing shortage is projected to grow to 260,000 RNs by 2025 because of a rapidly aging workforce (Buerhaus, Auerback, & Staiger, 2009). While the upcoming shortage receives much general attention, the causative factors need further examination and exploration in order to identify solutions. Some of the most significant factors fueling the nursing shortage in the United States relate to barriers in accepting qualified students into nursing education programs. In 2011, the American Association of Colleges of Nursing (AACN Press Release, 2011) reported that over 51,082 qualified applicants were denied admission to entry-level baccalaureate-level programs in 2011;
Journal of Professional Nursing, Vol 28, No. 6 (November/December), 2012: pp 377–380 © 2012 Elsevier Inc. All rights reserved.
377 http://dx.doi.org/10.1016/j.profnurs.2012.04.015
378
AACN anticipates that this number will increase when the final data is available in March 2012. AACN also reported that the primary barriers to accepting all qualified applicants into nursing colleges and universities continue to be a shortage of clinical education sites, poor funding or reduced budgets for nursing education, and a shortage of nurse faculty. A major factor driving the shortage of faculty emanates from the current trend in basic nursing education that is increasing the proportion of nurses with an associate degree in nursing (ADN) as their terminal professional education. Community colleges (CCs), which offer the associate degree, play a crucial role in providing access to nursing education. However, they now account for more than two thirds of all new nursing graduates in the United States. In addition, among those ADN graduates who pursue a bachelor of science in nursing (BSN), the average time between their ADN and attaining the BSN averages 7.5 years (Department of Health and Human Services, 2010). This delay in pursuing the BSN further decreases the pool of nurses poised to pursue graduate education that is necessary for the nursing faculty role. In North Carolina (NC), there is also a current shortage of nursing faculty that prevents expanding admissions to nursing programs. In October 2010, 183 full-time and 136 part-time positions were reported as unfilled in NC (NC Board of Nursing [NCBON], 2011). One component of this faculty shortage is the inadequate pipeline of nurses who are academically prepared to enter faculty roles. Eighty percent of the nurses in NC who hold master's degrees began their nursing education at the BSN level. In 2010, over 65% of new RN nursing graduates in NC were educated in ADN programs (NCBON, 2010). The vast majority of nurses who come from and return to the more rural and medically underserved areas of the state are prepared at the associate degree level. Although graduation from the 2-year ADN program may be seen as a relatively quick fix in increasing the number of RNs in the workforce, ADN nurses rarely obtain the educational requirements necessary for faculty roles. Although NC's nursing educators have worked diligently to facilitate articulation agreements between ADN and BSN programs, there continue to be insufficient numbers of ADN graduates continuing their education. In a 2006 longitudinal study conducted by the NC Center for Nursing, only 15% of nurses who graduated in nursing with an associate degree ever completed a bachelor's degree, and only 3% completed a master's in nursing. (Bevill, Cleary, Lacey, & Nooney, 2007) In a Cecil G. Sheps Center for Health Services Research (2010) review of highest earned degrees by associate degree RNs practicing in the state in 2008, 66% remained at the associate degree level, and less than 15% had obtained a BSN or higher degree in the field. In 2009, 63.4% of nurses completing the associate degree were in the 20–30 years age range, whereas 68% of the 1,392 associate degree nurses who completed a BSN degree were between 31 and 60 years of age. This age discrepancy further limits the length of service potential
HALL ET AL
for future nursing faculty who begin their careers at the associate degree level. With over two thirds of our new nurses completing only associate degree programs, the faculty pipeline in NC continues to decrease. This also means fewer BSN and higher-degree-prepared nurses available for advanced clinical practice, management roles, and public health services, all of which puts NC on a trajectory toward a serious nursing workforce crisis. It is therefore critical to identify and implement new pathways to increase the number of ADN graduates who complete baccalaureate education and, thereby, increase the percentage of BSN prepared nurses. Given the role CCs have in educating the workforce (NCIOM, 2004), a logical approach to remedy the shortage is to partner ADN and BSN programs, fostering dual enrollment of students from the start of their education. CCs are well distributed across NC; they draw students from their local areas and often return their graduates to practice in the community. Partnerships with baccalaureate programs provide mutual access to valuable resources that include broader faculty expertise, laboratories, libraries, and diverse student populations. The regionally increasing baccalaureate nurses (RIBN) model was designed with this in mind and fosters a longterm solution to an age-long problem. RIBN began as a pilot project. In September 2008, the Robert Wood Johnson Foundation and Northwest Health Foundation awarded a 2-year Partners Investing in Nursing's Future grant to the Jonas Center for Nursing Excellence in New York City for a multiregional project to develop the RIBN project in rural western NC (WNC) and in metropolitan New York. The NC Foundation for Nursing Excellence, Western Carolina University, and Asheville–Buncombe Technical CC partnered to develop the project in WNC. The purpose of the project was to synthesize work done by the Oregon Consortium for Nursing Education (OCNE; Tanner, Gubrud-Howe, & Shores, 2008) into a new model. OCNE was designed to be implemented at the state level and ultimately be inclusive of all public university and CCs with nursing programs. The RIBN model was designed for implementation at the regional level and provided the framework necessary for CCs and universities (whether public or private) to develop partnerships that would provide costeffective education and unique curricula to better prepare nurses at the baccalaureate level for the 21st century. The WNC RIBN partners have successfully developed and implemented the model and, in particular to date, has (a) established the dual entrance requirements for admission to both the CC and university, (b) received approval from both educational institutions for the 4-year WNC RIBN curriculum, (c) accepted the first cohort of WNC RIBN students who entered fall Semester 2010, (d) received approval from the NC Nurse Scholars Commission for RIBN to be recognized as a new BSN track in which approved applicants for this merit-based loan program would be eligible for up to 4 years of funding, and (e) implemented an ongoing evaluation process.
REGIONALLY INCREASING BACCALAUREATE-PREPARED NURSES
The power of RIBN resides in its potential to significantly increase, over a relatively short time frame, the proportion of new graduating nurses with baccalaureate degrees within a given project population, increase the number of nurses who are educated in public health and gerontological nursing, and greatly increase the pool of nurses poised to pursue graduate education. The RIBN model has been designed so that it allows states to incrementally “seed” regions with CC/university collaborative partnerships to increase BSN-prepared nurses based on their need and economic resources. For admission to the RIBN program, students must meet admission criteria that are more stringent than that of the general admission criteria either for CC or for university. The first 3 years of the program are home based at the CC with the student also taking a university course per semester, primarily on-line, to maintain university admission status and progress toward a baccalaureate degree. The on-line courses support the needs of the learner, particularly those in more rural areas of the state. During the first year, students take their liberal study courses. The second and third year involve nursing courses at the CC plus other university liberal studies courses and a rigorous course in pathophysiology. At the end of the third year, students will receive their ADN and are eligible to take the National Council Licensure Examination (NCLEX)-RN. Students must successfully pass the NCLEX to matriculate into the fourth year of the program taught at the university. The fourth year of the program provides an introduction to the roles of the baccalaureate-prepared nurse and more advanced content on gerontological nursing, community health nursing, use of evidencedbased nursing knowledge, and a strong focus on leadership. Students may work as RNs after the third year and during the fourth year of the program. This period between the third and fourth years of the program is considered a critical point for retention of students because they may wish to stop-out to earn income and not complete the BSN. The developers of the RIBN model are examining methods to insure retention between the third and fourth years and are utilizing a local advisory committee composed of leaders in all sectors of health care in the region to advise and support the project and its students. Critical to this process is the role of the student success advocate, a professional advisor that has been hired to market the RIBN program, advise students during and after the admission process, assist students in finding financial aid, and coordinate students' access to essential academic services such as remediation centers to support student success. The student completing this RIBN educational track will have a rigorous course of study with 3 years in a nursing curriculum as opposed to the traditional 2-year associate degree course of study at the CC or the typical 2-year BSN major offered in the upper division of undergraduate studies at 4-year university programs. The RIBN graduate will also have the opportunity to
379
utilize a broader base of educational resources and clinical experiences offered through both settings to achieve the level of preparation needed to respond to the complex health care needs of our citizens and build our future nursing workforce. The curriculum developed by the WNC partners is concept based and focuses on integrative teaching and clinical reasoning as recommended by Benner, Sutphen, Leonard, and Day (2010). The developers of the RIBN model have designed specific guidelines (see http://www.ffne.org/index.php? action=page&page_id=6) for development and implementation of RIBN in other regions of the state and country. With the successful implementation of RIBN in WNC, the Foundation for Nursing Excellence has developed five other regional partnerships throughout the state. These partnerships represent a mix of public and private CCs and universities ready to develop RIBN initiatives in their regions. The RIBN model provides a cost-effective method for different schools of nursing from different educational systems to work collaboratively in new ways. RIBN provides the opportunity for sharing curriculum and courses, thus eliminating duplication of effort. It provides for the opportunity to share scarce nursing faculty, particularly in high-demand specialties, that are difficult to recruit. By allowing students to complete the first 3 years of the program principally at a CC, this model also creates an economically feasible opportunity for more students from rural and medically underserved areas of the state to complete a BSN degree. Finally, the discipline of nursing is quickly moving to the doctorate of nursing practice (DNP) as the entry level for advanced practice nursing. The movement to the DNP makes sense because of the increasing complexities of the health care system and its patients. However, as a discipline, we have not yet solved the issue of basic entry-into-practice, and unless we solve this issue, the trajectory toward the DNP will cause an even greater crisis for the education of advanced practice nurses. In addition, the Institute of Medicine of the National Academies report on the future of nursing has recommended that the proportion of nurses with the BSN be increased to 80% by the year 2020 (IOM of the National Academies, 2011). New educational pathways for BSN education such as those developed by OCNE (Tanner et al., 2008) and the RIBN model can provide alternatives to increase the number of BSN-prepared nurses and support the “underbelly” of an educational system that will increase the pipeline for nurses poised to move into graduate nursing programs to create our future faculty and advanced practice workforce.
References American Association of Colleges of Nursing Press Release. (2011). New AACN data on nursing enrollments and employment of BSN graduates. Retrieved from http://www.aacn.nche. edu/news/articles/2011/11enrolldata. Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2011). Registered nurse supply grows faster than projected amid surge
380
in new entrants ages 23-26. Health Affairs, 30, 2286–2292. http://dx.doi.org/10.1377/hlthaff.2011.0588. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical reform. San Francisco, CA: Jossey-Bass. Bevill, J., Cleary, B., Lacey, L., & Nooney, G. (2007). Educational mobility of RNs in North Carolina: Who will teach tomorrow's nurses?: A report on the first study to longitudinally examine educational mobility among nurses. The American Journal of Nursing, 107, 60–70. Buerhaus, P. I., Auerback, D. I., & Staiger, D. O. (2009). The recent surge in nurse employment: Causes and implications. Health Affairs, 28, 657–668. http://dx.doi.org/10. 1377/hlthahh.28.4.w657. Bureau of Labor Statistics. (2012). The employment situation—May 2012. U. S. Department of Labor. Retrieved from http://www.bls.gov/news.release/pdf/empsit.pdf. Cecil G. Sheps Center for Health Services Research, University of North Carolina. (2010). Informal report of highest degrees earned by RNs practicing in North Carolina in 2008. Dolan, T. B. (2011). Has the nursing shortage come to an end? ONS Connect, 26, 8–12.
HALL ET AL
Department of Health and Human Services. (2010). Registered nurse population: Findings from the 2008 national sample survey of registered nurses. Retrieved from http://bhpr.hrsa.gov/ healthworkforce/rnsurveys/rnsurveyfinal.pdf. Institute of Medicine (IOM) of the National Academies. (2011). The future of nursing leading change, advancing health. Retrieved from http://books.nap.edu/openbook.php?record_id=12956. North Carolina Board of Nursing. (2011). North Carolina trends in nursing education: 2005–2010. Retrieved from http:// www.ncbon.com/content.aspx?id=1090. North Carolina Board of Nursing. (2010). Currently licensed RNs. Retrieved from http://www.ncbon.com/LicensureStats/ LicStat-RNWSTAT.asp. North Carolina Institute of Medicine (NCIOM). (2004). Task force on the North Carolina nursing workforce report. Retrieved from http://www.nciom.org/wp-content/uploads/ NCIOM/projects/nursingworkforce/fullreport.pdf. Olshansky, E. (2010). Is there still a nursing shortage? Journal of Professional Nursing, 26, 255–256. Tanner, C., Gubrud-Howe, P., & Shores, L. (2008). The Oregon Consortium for Nursing Education: A response to the nursing shortage. Policy, Politics & Nursing Practice, 9, 203–209.
T
HE STATE OF the nursing shortage in the United States has changed somewhat and is not currently as bleak as predicted. There are several factors that serve as indicators for this change, and they include the following: (a) the economic recession that has forced experienced nurses to return or remain in the workforce (Dolan, 2011), (b) the continued growth of the health care sector, unlike other major industries in the United States (Bureau of Labor Statistics, 2012), and (c) the increase in the number of young registered nurses (RNs; aged 23–
∗Director, School of Nursing, Western Carolina University, Cullowhee, NC. †Chair, Department of Nursing, Asheville-Buncombe Technical Community College, Asheville, NC. ‡Executive Director, Foundation for Nursing Excellence, Raleigh, NC. §Asheville, NC 28803. Address correspondence to Dr. Hall: Director, School of Nursing, Western Carolina University, Cullowhee, 19 Town Square Blvd., Apt. 206, Asheville, NC 28803. E-mail: [email protected] 8755-7223/12/$ - see front matter
26 years), measured as full-time equivalent RNs, that has increased by 62% between 2002 and 2009 (Auerbach, Buerhaus, & Staiger, 2011). However, in spite of these factors, the nursing shortage remains an acute problem at the national level (Olshansky, 2010) and significantly endangers the provision of safe and effective health care. Further, despite the current easing of the shortage because of the recession and other factors, the nursing shortage is projected to grow to 260,000 RNs by 2025 because of a rapidly aging workforce (Buerhaus, Auerback, & Staiger, 2009). While the upcoming shortage receives much general attention, the causative factors need further examination and exploration in order to identify solutions. Some of the most significant factors fueling the nursing shortage in the United States relate to barriers in accepting qualified students into nursing education programs. In 2011, the American Association of Colleges of Nursing (AACN Press Release, 2011) reported that over 51,082 qualified applicants were denied admission to entry-level baccalaureate-level programs in 2011;
Journal of Professional Nursing, Vol 28, No. 6 (November/December), 2012: pp 377–380 © 2012 Elsevier Inc. All rights reserved.
377 http://dx.doi.org/10.1016/j.profnurs.2012.04.015
378
AACN anticipates that this number will increase when the final data is available in March 2012. AACN also reported that the primary barriers to accepting all qualified applicants into nursing colleges and universities continue to be a shortage of clinical education sites, poor funding or reduced budgets for nursing education, and a shortage of nurse faculty. A major factor driving the shortage of faculty emanates from the current trend in basic nursing education that is increasing the proportion of nurses with an associate degree in nursing (ADN) as their terminal professional education. Community colleges (CCs), which offer the associate degree, play a crucial role in providing access to nursing education. However, they now account for more than two thirds of all new nursing graduates in the United States. In addition, among those ADN graduates who pursue a bachelor of science in nursing (BSN), the average time between their ADN and attaining the BSN averages 7.5 years (Department of Health and Human Services, 2010). This delay in pursuing the BSN further decreases the pool of nurses poised to pursue graduate education that is necessary for the nursing faculty role. In North Carolina (NC), there is also a current shortage of nursing faculty that prevents expanding admissions to nursing programs. In October 2010, 183 full-time and 136 part-time positions were reported as unfilled in NC (NC Board of Nursing [NCBON], 2011). One component of this faculty shortage is the inadequate pipeline of nurses who are academically prepared to enter faculty roles. Eighty percent of the nurses in NC who hold master's degrees began their nursing education at the BSN level. In 2010, over 65% of new RN nursing graduates in NC were educated in ADN programs (NCBON, 2010). The vast majority of nurses who come from and return to the more rural and medically underserved areas of the state are prepared at the associate degree level. Although graduation from the 2-year ADN program may be seen as a relatively quick fix in increasing the number of RNs in the workforce, ADN nurses rarely obtain the educational requirements necessary for faculty roles. Although NC's nursing educators have worked diligently to facilitate articulation agreements between ADN and BSN programs, there continue to be insufficient numbers of ADN graduates continuing their education. In a 2006 longitudinal study conducted by the NC Center for Nursing, only 15% of nurses who graduated in nursing with an associate degree ever completed a bachelor's degree, and only 3% completed a master's in nursing. (Bevill, Cleary, Lacey, & Nooney, 2007) In a Cecil G. Sheps Center for Health Services Research (2010) review of highest earned degrees by associate degree RNs practicing in the state in 2008, 66% remained at the associate degree level, and less than 15% had obtained a BSN or higher degree in the field. In 2009, 63.4% of nurses completing the associate degree were in the 20–30 years age range, whereas 68% of the 1,392 associate degree nurses who completed a BSN degree were between 31 and 60 years of age. This age discrepancy further limits the length of service potential
HALL ET AL
for future nursing faculty who begin their careers at the associate degree level. With over two thirds of our new nurses completing only associate degree programs, the faculty pipeline in NC continues to decrease. This also means fewer BSN and higher-degree-prepared nurses available for advanced clinical practice, management roles, and public health services, all of which puts NC on a trajectory toward a serious nursing workforce crisis. It is therefore critical to identify and implement new pathways to increase the number of ADN graduates who complete baccalaureate education and, thereby, increase the percentage of BSN prepared nurses. Given the role CCs have in educating the workforce (NCIOM, 2004), a logical approach to remedy the shortage is to partner ADN and BSN programs, fostering dual enrollment of students from the start of their education. CCs are well distributed across NC; they draw students from their local areas and often return their graduates to practice in the community. Partnerships with baccalaureate programs provide mutual access to valuable resources that include broader faculty expertise, laboratories, libraries, and diverse student populations. The regionally increasing baccalaureate nurses (RIBN) model was designed with this in mind and fosters a longterm solution to an age-long problem. RIBN began as a pilot project. In September 2008, the Robert Wood Johnson Foundation and Northwest Health Foundation awarded a 2-year Partners Investing in Nursing's Future grant to the Jonas Center for Nursing Excellence in New York City for a multiregional project to develop the RIBN project in rural western NC (WNC) and in metropolitan New York. The NC Foundation for Nursing Excellence, Western Carolina University, and Asheville–Buncombe Technical CC partnered to develop the project in WNC. The purpose of the project was to synthesize work done by the Oregon Consortium for Nursing Education (OCNE; Tanner, Gubrud-Howe, & Shores, 2008) into a new model. OCNE was designed to be implemented at the state level and ultimately be inclusive of all public university and CCs with nursing programs. The RIBN model was designed for implementation at the regional level and provided the framework necessary for CCs and universities (whether public or private) to develop partnerships that would provide costeffective education and unique curricula to better prepare nurses at the baccalaureate level for the 21st century. The WNC RIBN partners have successfully developed and implemented the model and, in particular to date, has (a) established the dual entrance requirements for admission to both the CC and university, (b) received approval from both educational institutions for the 4-year WNC RIBN curriculum, (c) accepted the first cohort of WNC RIBN students who entered fall Semester 2010, (d) received approval from the NC Nurse Scholars Commission for RIBN to be recognized as a new BSN track in which approved applicants for this merit-based loan program would be eligible for up to 4 years of funding, and (e) implemented an ongoing evaluation process.
REGIONALLY INCREASING BACCALAUREATE-PREPARED NURSES
The power of RIBN resides in its potential to significantly increase, over a relatively short time frame, the proportion of new graduating nurses with baccalaureate degrees within a given project population, increase the number of nurses who are educated in public health and gerontological nursing, and greatly increase the pool of nurses poised to pursue graduate education. The RIBN model has been designed so that it allows states to incrementally “seed” regions with CC/university collaborative partnerships to increase BSN-prepared nurses based on their need and economic resources. For admission to the RIBN program, students must meet admission criteria that are more stringent than that of the general admission criteria either for CC or for university. The first 3 years of the program are home based at the CC with the student also taking a university course per semester, primarily on-line, to maintain university admission status and progress toward a baccalaureate degree. The on-line courses support the needs of the learner, particularly those in more rural areas of the state. During the first year, students take their liberal study courses. The second and third year involve nursing courses at the CC plus other university liberal studies courses and a rigorous course in pathophysiology. At the end of the third year, students will receive their ADN and are eligible to take the National Council Licensure Examination (NCLEX)-RN. Students must successfully pass the NCLEX to matriculate into the fourth year of the program taught at the university. The fourth year of the program provides an introduction to the roles of the baccalaureate-prepared nurse and more advanced content on gerontological nursing, community health nursing, use of evidencedbased nursing knowledge, and a strong focus on leadership. Students may work as RNs after the third year and during the fourth year of the program. This period between the third and fourth years of the program is considered a critical point for retention of students because they may wish to stop-out to earn income and not complete the BSN. The developers of the RIBN model are examining methods to insure retention between the third and fourth years and are utilizing a local advisory committee composed of leaders in all sectors of health care in the region to advise and support the project and its students. Critical to this process is the role of the student success advocate, a professional advisor that has been hired to market the RIBN program, advise students during and after the admission process, assist students in finding financial aid, and coordinate students' access to essential academic services such as remediation centers to support student success. The student completing this RIBN educational track will have a rigorous course of study with 3 years in a nursing curriculum as opposed to the traditional 2-year associate degree course of study at the CC or the typical 2-year BSN major offered in the upper division of undergraduate studies at 4-year university programs. The RIBN graduate will also have the opportunity to
379
utilize a broader base of educational resources and clinical experiences offered through both settings to achieve the level of preparation needed to respond to the complex health care needs of our citizens and build our future nursing workforce. The curriculum developed by the WNC partners is concept based and focuses on integrative teaching and clinical reasoning as recommended by Benner, Sutphen, Leonard, and Day (2010). The developers of the RIBN model have designed specific guidelines (see http://www.ffne.org/index.php? action=page&page_id=6) for development and implementation of RIBN in other regions of the state and country. With the successful implementation of RIBN in WNC, the Foundation for Nursing Excellence has developed five other regional partnerships throughout the state. These partnerships represent a mix of public and private CCs and universities ready to develop RIBN initiatives in their regions. The RIBN model provides a cost-effective method for different schools of nursing from different educational systems to work collaboratively in new ways. RIBN provides the opportunity for sharing curriculum and courses, thus eliminating duplication of effort. It provides for the opportunity to share scarce nursing faculty, particularly in high-demand specialties, that are difficult to recruit. By allowing students to complete the first 3 years of the program principally at a CC, this model also creates an economically feasible opportunity for more students from rural and medically underserved areas of the state to complete a BSN degree. Finally, the discipline of nursing is quickly moving to the doctorate of nursing practice (DNP) as the entry level for advanced practice nursing. The movement to the DNP makes sense because of the increasing complexities of the health care system and its patients. However, as a discipline, we have not yet solved the issue of basic entry-into-practice, and unless we solve this issue, the trajectory toward the DNP will cause an even greater crisis for the education of advanced practice nurses. In addition, the Institute of Medicine of the National Academies report on the future of nursing has recommended that the proportion of nurses with the BSN be increased to 80% by the year 2020 (IOM of the National Academies, 2011). New educational pathways for BSN education such as those developed by OCNE (Tanner et al., 2008) and the RIBN model can provide alternatives to increase the number of BSN-prepared nurses and support the “underbelly” of an educational system that will increase the pipeline for nurses poised to move into graduate nursing programs to create our future faculty and advanced practice workforce.
References American Association of Colleges of Nursing Press Release. (2011). New AACN data on nursing enrollments and employment of BSN graduates. Retrieved from http://www.aacn.nche. edu/news/articles/2011/11enrolldata. Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2011). Registered nurse supply grows faster than projected amid surge
380
in new entrants ages 23-26. Health Affairs, 30, 2286–2292. http://dx.doi.org/10.1377/hlthaff.2011.0588. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical reform. San Francisco, CA: Jossey-Bass. Bevill, J., Cleary, B., Lacey, L., & Nooney, G. (2007). Educational mobility of RNs in North Carolina: Who will teach tomorrow's nurses?: A report on the first study to longitudinally examine educational mobility among nurses. The American Journal of Nursing, 107, 60–70. Buerhaus, P. I., Auerback, D. I., & Staiger, D. O. (2009). The recent surge in nurse employment: Causes and implications. Health Affairs, 28, 657–668. http://dx.doi.org/10. 1377/hlthahh.28.4.w657. Bureau of Labor Statistics. (2012). The employment situation—May 2012. U. S. Department of Labor. Retrieved from http://www.bls.gov/news.release/pdf/empsit.pdf. Cecil G. Sheps Center for Health Services Research, University of North Carolina. (2010). Informal report of highest degrees earned by RNs practicing in North Carolina in 2008. Dolan, T. B. (2011). Has the nursing shortage come to an end? ONS Connect, 26, 8–12.
HALL ET AL
Department of Health and Human Services. (2010). Registered nurse population: Findings from the 2008 national sample survey of registered nurses. Retrieved from http://bhpr.hrsa.gov/ healthworkforce/rnsurveys/rnsurveyfinal.pdf. Institute of Medicine (IOM) of the National Academies. (2011). The future of nursing leading change, advancing health. Retrieved from http://books.nap.edu/openbook.php?record_id=12956. North Carolina Board of Nursing. (2011). North Carolina trends in nursing education: 2005–2010. Retrieved from http:// www.ncbon.com/content.aspx?id=1090. North Carolina Board of Nursing. (2010). Currently licensed RNs. Retrieved from http://www.ncbon.com/LicensureStats/ LicStat-RNWSTAT.asp. North Carolina Institute of Medicine (NCIOM). (2004). Task force on the North Carolina nursing workforce report. Retrieved from http://www.nciom.org/wp-content/uploads/ NCIOM/projects/nursingworkforce/fullreport.pdf. Olshansky, E. (2010). Is there still a nursing shortage? Journal of Professional Nursing, 26, 255–256. Tanner, C., Gubrud-Howe, P., & Shores, L. (2008). The Oregon Consortium for Nursing Education: A response to the nursing shortage. Policy, Politics & Nursing Practice, 9, 203–209.