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Collaborative Models Offer New Route to Nursing Education

Changing face of health care brings different venues of education for nurses

By Sarah Nemeth and Deloras Jones, RN, MS

California is performing surgery on its nursing education options, opting for a mix of nursing training and leadership courses for field entrants to earn a baccalaureate degree in a streamlined fashion.

In 2008, a group of California nursing leaders began the quest toward meeting changing health care needs.

42% of new associate's degree nursing program graduates without a job say not having a BSN is the reason. - 2011 CINHC study

“There were calls for nursing education redesign to better meet the evolving health care needs of California,” said Deloras Jones, Executive Director of the California Institute for Nursing & Health Care. “One driving force for this was the demand for more nurses educated at a higher level.”

The thought leaders organized to explore education redesign found that the collaborative model was the most effective path toward a more highly educated nursing workforce, Jones said. This model of education is founded on relationships between community colleges that offer an associate's degree in nursing and universities that offer a baccalaureate program in nursing. The collaborative model is designed to provide seamless progression from the AD to the BSN. In collaborative model relationships, duplicate courses are removed, allowing students to earn their BSN with an additional year of study following the completion of their associate's degree thanks to an integrated curriculum and dual admission at a baccalaureate college.

A 2011 study done by the California Institute for Nursing & Health Care (CINHC) and other nursing and educational organizations indicated that 42 percent of new nursing school graduates unable to find employment as a RN cited the lack of a baccalaureate degree as the reason they have been denied jobs.

“We find that ADN students actually want to go on to obtain a BSN, yet in California, only 25 percent of ADN graduates go on to earn a BSN. It's not that they don't want to continue with their education, it's that we have created barriers that make it difficult for them to go on,” Jones shares.

Barriers include: Duplicate courses, overlapping instructions, transcripts requests, qualifying exams, portfolio presentations, and challenging schedules, not generally designed for the working nurse. Furthermore, tucked inside California’s state budget this year is a 20 percent decrease in funding for the state’s university system, including a cap on the number of students enrolled for a BSN.

Jones points out, “in order for California to have enough nurses educated at the baccalaureate degree level and higher, we need to build upon the contribution of our community colleges and the collaborative model is an answer to this problem."

“With the collaborative model we’re calling for dual enrollment so while [a student is in a] community college program, they will have enrolled into the baccalaureate program so that mentally they're now on the baccalaureate track,” Jones explains.

Only 25 percent of ADN graduates go on to earn a BSN. - Deloras Jones, RN, MS

Jones enthusiastically shares that, “we're hopeful that we can move in a direction in which a seamless progression between associates and baccalaureate will be an avenue available to all associate degree nurses. That's what we're aiming for."

Why the call for Baccalaureate training?

In days past, an associate degree was all a nurse needed to enter the field well-armed to succeed in hospital practice. These days, health care reform has skewed the axis that medicine in the United States spins on.

“Our current model is a system that takes care of medical crises, takes care of people who are sick,” Jones said. “With health care reform, we must change to a health driven model of care delivery. Our focus needs to be on keeping people healthy and out of acute care facilities.”

"One goal with health care reform is to create teams of nurse practitioners and physician assistants working with physicians to increases access to primary care. A nurse practitioner or physician assistance can do about 80 percent of primary care needed, freeing up the physician to provide the more complicated aspects of primary care. This team based care maximizes the contribution of all primary care providers." Jones said.

“Also, with health care reform, it is expected that new models of care will emerge with nurses functioning in roles called chronic disease managers—working with patients who have chronic diseases and keeping them out of a medical crises situation.”

Other nursing roles will include preventive work to decrease effects of diabetes, and follow-up with cancer care and heart disease.

“In order to have nurses that can serve as advanced care providers, we need more nurses that are educated with a baccalaureate degree,” Jones deftly states.

New paradigm + more education = job

As the mind-set of Westerners changes into a more preventative style of medicine, trends in nursing education are likely follow suit.

And right now, during a national economic slump, retiring age nurses are not leaving their jobs, and those working part time hours are seeking full time jobs. Because they are experienced, existing nurses are more likely to be bumped up to full time work leaving recent graduates still looking for their first job.

“When the economy turns, we're going to have a major shortage [of nurses] glaring in our faces once again. The nursing shortage is not over with, it's just being masked by our economy,” Jones said.

"Earning a BSN or graduate degree is the best way for a nurse to prepare for coming changes in American health care," Jones said.

“The baccalaureate [and masters] degree opens up so many more professional doors to nurses, doors that will continue to open with health care reform,” she said. “Regardless of what happens with the Affordable Care Act, the train has left the station. Things will never be the same in the US. Health care reform is underway.”

"The nursing shortage is not over with, it's just being masked by our economy.” - Deloras Jones, RN, MS

So, Jones suggests, if you are just out of high school, the best route is straight to a baccalaureate degree nursing program. If that is not an option, earning an associate’s degree in nursing at a community college is a good place to start, but view this a the first step in your professional journey as a nurse and plan to continue to obtain a BSN, and perhaps even a MSN or doctoral degree in nursing, Jones suggests. A master's is entry level for roles such as a nurse practitioner or nurse midwife.

Recommendations for the Career Changers

For those who are changing careers and entering the nursing field, she offers two suggestions how to get there:

  • First, some universities offer the fast-track BSN. Nursing hopefuls who already have a Bachelor of Arts degree can go back to school and earn a BSN in about a year after completing the required pre-requisites. The course is intense, but programs with twelve months of study can be a good option, Jones said.
  • Also, for those with a baccalaureate degree who are looking to enter the nursing field at a higher level, an entry-level master’s degree is an option. With this degree, graduates can become nurse practitioners or other advance practice nurse. To start this track, students enter at the graduate level, complete the baccalaureate portion of the curriculum and continue through the master’s level. The whole degree can be complete in three-to-four years, Jones said.

Nursing education is changing and so is health care. Deloras Jones shares several routes to nursing and advanced nursing education and how the collaborative model is a solution to many of the barriers facing associate's degree educated nurses returning to school. The underlining is the importance of the educational path and pursuing higher education on that path.

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