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Supporting Nursing Students

By educating students in their own communities, consensus has it many will stay.

Editor's Note: This is part one of a three-part series on initiatives across the country to relieve an expected future nursing shortage.

With the poor economy and few hospitals hiring, it's hard to believe the U.S. will be "substantially short more than 260,000 registered nurses" by 2025, according to a recent report by the Robert Wood Johnson Foundation (RWJF).

The problem is complex, complicated by the present sluggish economy. Basically, the population continues to age, increasing the demand for healthcare.

Before the recession, many veteran nurses were ready to retire or were leaving the profession for other reasons. Now, they are hanging onto jobs because of shrinking retirement investments, spouses whose jobs are not secure, etc. That has caused thousands of eager new nursing graduates to be turned away from nursing jobs all over the country each year.

However, as nursing faculty are aging out, nursing schools are turning away applicants for lack of qualified nurse educators, clinical experiences or resources. And nurse workforce researchers such as Peter Buerhaus, PhD, RN, FAAN, say as soon as the economy improves, the nursing shortage will get very severe.

Any solutions, like the problem, must be multi-faceted and creative, and there are quite a few creative programs being developed across the country.

Westward to Oregon

One promising program in Oregon is serving as a model for other states.

Oregon's seamless pathways program provides nursing students an uninterrupted route from a community college to a university program where they graduate with a bachelor's degree.

But that's a simplistic version of what's being done in the Beaver State. The broader view: Nursing leaders there recognize the role of the nurse must evolve and they are making bold strides toward shaping curriculum for what they call the "new nurse."

By developing curriculum to focus more on community-based care health promotion and chronic illness management, and by encouraging nurses to achieve more education, they are in a sense tackling the future nursing shortage from multiple angles.

Nurses with bachelor's degrees are more likely to go on to higher education and eventually become educators, studies show. This means more slots at nursing schools for more students, and more better-qualified nurses.

How It Got Started in Oregon

In reviewing data from a statewide study on the nursing shortage, members of the Oregon Nursing Leadership Council developed a strategic plan about 10 years ago with two major goals in mind, said Chris A. Tanner, PhD, RN, FAAN, a professor at Oregon Health & Science University School of Nursing and director of Strategic Initiatives for the Oregon Consortium of Nursing Education (OCNE). The consortium formed a single curriculum that would take students through their associate's degree straight into a 4-year program. Currently eight community colleges and five universities are participating.

Goal No. 1 was to double enrollment in baccalaureate nursing programs. Goal No. 2: to more closely align education programs with current healthcare needs and changing practices.

With "strong leadership throughout the state, 15 nursing leaders made it happen," Tanner said. She was one of three nursing leaders who focused primarily on curriculum. She also wrote grants, bringing in about $5 million from national and local foundations as well as some federal government money.

Bringing these institutions together was no small feat, as community college and university nursing schools have traditionally been rivals. But in this case, "it was a moral obligation," said Tanner, with all stakeholders realizing, "We've got a huge crisis in front of us and we need to set aside our differences and work toward a shared goal."

Oregon's No. 1 Goal

Now having graduated two classes at the baccalaureate level, Oregon is already beginning to show positive results toward their first goal, seeing the number of community college graduates who are seeking bachelor's degrees rise to 40 percent. That's only halfway to the 80 percent goal set, but it's still double the national average, Tanner noted.

Students complete 3 years at the community college level and one more at the university level, usually via distance learning.

Based on early research, finances were identified as a main obstacle for many nursing students. "This requires solutions, especially with this current economic downturn," said Tanner.

Nursing leaders need to work more with employers to give nurses incentives to continue their education. Also, making curriculum more seamless and helping students become more comfortable with taking classes online are helpful.

Versatile Faculty

Some benefits from the program include nursing faculty throughout the state who can teach across institutional lines, facilitated by having the same curriculum across all 13 campuses. This goes both ways. University professors can fill in gaps at the community college level, teaching courses like pathophysiology to students on one or more campuses using distance delivery methods. But some community college educators are providing clinical instruction in senior-level university courses.

This capability to share faculty occurred during development of the consortium and creation of a shared curriculum. This has proven especially beneficial in rural areas, where nurse educators are limited.

Another benefit, which ultimately benefits nurse educators, is the creation of "a whole warehouse of instructional aids" developed by faculty with expertise in specific areas, such as pharmacology for example, said Tanner. This web-based repository saves educators valuable time because they don't have to create everything from scratch.

Oregon's Second Goal

While they're beginning to attain their first goal of increasing the number of baccalaureate nurses in the state, nursing leaders in Oregon understood changing the role of nurses would take longer and be more complex.

"We realized we really needed to change the way we do business; to identify the competencies of what we call the "new nurse," she said. "This is the first major change in 75 years in clinical education," said Tanner, explaining the state is still not close to implementation, as nursing leaders continue to "work out issues" in what is being called the OCNE Clinical Education Model. Basically, clinical education reform is needed so students learn more skills to handle the complexities of patients with chronic illness requiring long periods of care, oftentimes in their own homes.

"The population we serve has changed enormously," emphasizes Tanner. Most people over age 60 have at last one chronic condition, and many develop four, five and six comorbidities as they age, she explained. Thus the future nurse's role will move away from acute care practice toward that of being a coordinator for care that may be provided by family members or other at-home caregivers. Appropriate clinical experiences must be incorporated into student nurse clinical education. With limited resources, some of this training will likely be provided through simulation or via trained actors.

In Oregon's Footsteps

And the Oregon program is going on the road, so to speak. "We think of ourselves as having done a national experiment at a local level and we've been able to work out a lot of the bugs," said Tanner, who has consulted with the New York-North Carolina Regionally Increasing Baccalaureate Nurses (RIBN) Project, as well as nursing leaders in many other states. RIBN is important because it tests Oregon's model in two different geographic environments, urban and rural.

The University of Hawaii and three community colleges have partnered in a program based on Oregon's model, accepting their first students this fall. California has six regional consortiums, while Minnesota and Connecticut are moving ahead with their own programs, and Massachusetts is just in the planning stages.

OCNE leaders have also worked with nursing leaders in Wyoming and New Mexico, and served as consultant to as many as 30 states through webinars.

Such programs are getting off the ground through administrative and oftentimes financial support and advocacy by nursing organizations and foundations like RWJF, which is supporting  a comprehensive evaluation of Oregon's program and the development of "lessons learned" documents to assist in its replication in other states.

Supporting Nursing Students

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