CHW Spring Conference
April 22, 2014
Lorie Judson, PhD, RN, NP Associate Professor
Chair BSN Programs CSULA
Betsy Manchester, MN, RN, FNP, CNE
ADN to BSN Program Coordinator CSULA
Carolyn Orlowski, MSN, RN
Regional Coordinator CINHC
1
Presentation Objectives
1. Identify needs and challenges related
to advancing ADN to BSN education in
California’s nursing workforce
2. Explore an emerging model of ADN to BSN
education implemented at CSULA with 10
Community College Partners
3. Determine transferrable success
strategies applicable to other programs that
support and advance career mobility
2
California Institute for Nursing &
Health Care (CINHC) www.cinhc.org
 Founded in 2001, a nonprofit 501©(3) independent
organization dedicated to transforming the capacity of
nurses to meet the evolving health needs of Californians
 Designated nursing workforce center for California
 Home of California Action Coalition accountable to carry out
the Institute of Medicine Future of Nursing Recommendations
 CINHC partners with nursing leaders and health care
organizations to develop practical solutions in 4 key areas:
 Statewide Master Plan (White Paper Nursing Education Redesign)
 Expanding educational capacity
 Increasing workforce & diversity recruitment and retention initiatives
 Developing nurse leaders capable in meeting challenges of a changing
environment
3
California Picture: Substantial Progress
in RN Workforce Growth
 400,000+ Licensed RNs in California: 14% of USA (2013)
 657 employed RN’s per 100,000 population
California ranks low at 48 (National average = 825)
 Number of new RNs grew 83% past 10 years
 Workforce becoming more diverse in last decade
- proportion non-white RNs increasing from 23% to 47%
- proportion of males increasing from 5.8% to 11.6%
 BSN prepared RN candidates doubled (2001-2012)
 86.3% increase - annual number RN to BSN program graduates
over the last four years (1,600 graduates in 2012)
 53% of the RN workforce holds a bachelor’s or higher degree
4
Snap Shot of New Graduate RN Hiring
In California Hospitals (2013)
 Hospital vacancy rates trending low 3.8% (2013)
 Supply (# newly licensed RNs) and forecasted workforce
demand (# of RNs needed) currently “in balance”
 Impact of economic crisis and shift in health care services
are changing employment settings and hiring patterns
69% employed in hospitals 2012 (88% 2007)
 Statewide employer surveys reflect education hiring trends
BSN preferred 68% or BSN required 7%
 Statewide survey of new RN graduates found differences in
employment rates by type of degree (within first 12 months
after receiving RN license)
ADN 55%
BSN 63%
ELM 68%
5
The Future of Nursing: Leading Change,
Advancing Health
(Institute of Medicine Report 2009)
6
 Institute of Medicine (IOM) under direction of Robert
Wood Johnson Foundation (RWJF) commissioned report“The Future of Nursing: Leading Change, Advancing
Health”
 Campaign for Action formed as a result by RWJF
 Center to Champion Nursing in America (CCNA) RWJF at
AARP formed to implement the recommendations
 Action Coalitions formed across the US, now 51 of them [in
CA- California Action Coalition (CAAC)] to work on
implementing these recommendations at the state level
National Recommendations and
Campaign for Action
1.
2.
3.
4.
5.
6.
7.
8.
Remove scope of practice barriers
Expand opportunities for nurse to lead and diffuse
collaboration
Implement nurse residency programs
Increase the proportion of nurses with BSN degrees to
80% by 2020
Double the number of nurses with doctorate by 2020
Ensure that nurses engage in lifelong learning
Prepare and enable nurses to lead change to advance
health
Build an infrastructure for the collection and analysis of
inter-professional health care workforce data
8
Registered Nurses: Potential to Effect
Wide-Reaching Healthcare Change !
Largest component of
health care workforce
Spend most time with
patients
Understand care process
across continuum of care
Evidence links them to
high-quality patient care
9
Compelling Challenges: Healthcare
More nurses prepared at higher levels of education are
needed to meet evolving healthcare demands
 Aging population, complex health management
 Health care reform with trends toward non acute care
settings/home health/public health (BSN degree includes
Community/Public Health Certification)
 Specialty care and advanced practice roles including primary
care providers (APNs, Nurse Practitioners)
 Emerging “new "roles for nursing involving care coordination
and managing patient populations
 Nursing faculty, leadership, and research positions
F
Compelling Challenges: Higher
Educated Workforce
 Education mix of new graduates in California (2013 N=11,292)
57% ADN
37% BSN
6% ELM
 RN workforce with BSN or higher degree
(increased 14.2% since 1990, relatively flat last 6 years)
54.1% (2006) 53.9% (2008) 53.2% (2010) 53.2% (2012)
 IOM Goal: 80% BSN or higher degree in RN workforce by 2020
 California’s challenge:
- Large ADN workforce (47% < BSN Degree or 188,888 nurses)
- Large number of ADN graduates entering workforce each year
- Barriers to return to school for higher degree (only 22% of RNs return)
- Average time for ADN nurses who do obtain BSN degree: 9.4years
- Limited number of RN to BSN programs in California: 33 programs
(1,600 nurses graduated in 2013) and reduced state funding to CSUs
- Workforce diversity gap compared to general population
11
California RN Diversity Snapshot
Hispanic and Black RNs Underrepresented in Workforce
12
Projected Difference Between RNs
and the General Population by Race
13
Ethnic Distribution California Pre-Licensure
Nursing Students (5 primary groups)
California BRN Annual School Report (May 2013)
Ethnicity
ADN
LVN to
ADN
BSN
ELM
Total
Asian
14%
10%
18%
25%
17%
African
American
Filipino
6%
2%
4%
10%
6%
9%
16%
13%
3%
10%
Hispanic
22%
15%
16%
13%
17%
White
42%
44%
37%
39%
40%
14
Compelling Opportunity: Career Mobility
and Increased Salary With BSN-MSN Degree
 Broader job opportunities in a greater range of settings
 Potential for promotion to specialized roles
 Annual income reported by California RNs
(2012 USF Statewide Sample Survey conducted for the BRN)
Degree or Role
Associate Degree
$84,839
Baccalaureate Degree
$92,326
Master’s Degree
$99,042
Public Health Nurse (BSN or MSN)
$90,715
Nurse Practitioner (MSN)
$93,493
Clinical Nurse Specialist (MSN)
$100,482
15
Strategies and Initiatives to Advance
Academic Progression (ADN to BSN)
 Implement emerging models for ADN to BSN Education
 Strengthen employer partnerships in academic program





growth; increase clinical education capacity
Provide financial and professional support to employees
to return to school for BSN or MSN degrees
Engage broad student interest to advance diversity
Support academic success (K-12 and High School) and
with currently enrolled nursing students - retention
Expand funding - support for public school growth of
BSN and MSN programs (CSUs)
Increase BSN & MSN workforce through seamless access
to various education pathway options
16
California Journey: Collaborative Model
of Nursing Education (CCMNE)
17
Criteria for CA CMNE
Dual Admission
Integrated Curriculum & QSEN
Share Faculty
BSN Attainable in One Year after ADN
Program Sustainability/Permanence
California Collaborative Model of ADN to BSN
Education (CCMNE) (CINHC sponsored model)
 11/19 CSUs and 50/78 CCCs have implemented a dual
enrollment CCMNE program with shared curriculum for
streamlined ADN to BSN degree mobility
 AB 1295 signed into law requiring no duplication of
coursework between CCCs and CSUs
 Leadership support from CSU & CCC Chancellors Offices
to adopt and agree on BSN pre-requisites statewide; all
CSUs developed ADN to BSN curriculum “roadmaps”
 Model leverages ethnic diversity found in Community
College student population
 Model supports access for economically disadvantaged
students to obtain a BSN degree
 Model reduces time and cost for students to obtain a BSN
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Lorie Judson, RN, PhD, NP
Associate Director CSULA SON Chair of BSN Programs
Project Director , APIN LA Area Collaborative
P. Betsy Manchester, MN, RN, FNP, CNE
Coordinator APIN ADN/BSN Program
 RN-BSN has been an important mission of the SON
for 60 years
 Several on-site programs during these years at area
medical centers to educate nursing employees from
ADN- BSN and BSN to MSN
 Alliance with several community colleges for
transition programs have been made in various
configurations
 Continue to provide a “traditional” RN-BSN program
for working nurses through state support
 Increase the number of registered nurses educated at
the baccalaureate (BSN) degree based on the Associate
Degree (AD) as a foundation.
 Increase access to BSN education in a seamless, timely
and cost effective manner.
 Increases number of nurses from economically and
socially disadvantaged groups who have a BSN degree.
 Administered by the American Organization of Nurse
Executives (AONE) on behalf of the Tri-Council for
Nursing consisting of –
 American Association of Colleges of Nursing (AACN)
 National League for Nursing (NLN)
 American Nurse Association (ANA)
 These organizations represent nurses in practice,
nurse executives and nurse educators
 Grant offered by RWJF - $300,000 for 2 years to Action
Coalitions that could show they would increase the
number of BSN nurses in their state
 Nine states chosen- California, Hawaii, Massachusetts,
Montana, New Mexico, New York, North Carolina,
Texas and Washington.
 California will focus on implementation of
collaborative model of nursing education- CSULA and
ten community colleges
Campaign for Action - RWJF
CCNA
(The Center to Champion
Nursing in America at AARP)
51 Action
Coalitions
9
Action
Coalitions
with APIN
Funding
APIN
Tri-Council
* AONE - National Program
AACN
ANA
NLN
 October 11, 2009- Governor signed this Assembly Bill
 Calls for systemic change requiring the Chancellor of
the CSU to implement seamless articulated nursing
degree pathways between California Community
Colleges (CCC) and CSU prior to the 2012-2013
academic year.
 Removes system barriers to seamless progression of
nursing education
AB 1295 requires that by Fall 2012 the California State University
AND the California Community College Chancellor’s Offices must
implement “articulated nursing degree pathways.”
No repeat of prerequisite courses or
course content required for the ADN
Identify additional
components to be included
that provide a streamlined
nursing degree transfer
pathway
No duplication of BRN pre-licensure
or ADN required course content
CRITERIA
AB 1295
CA CMNE
Dual Admission
Integrated Curriculum &
QSEN
“Articulated Nursing Degree
Pathways”
Share Faculty
BSN Attainable in One
Year after ADN
No repetition of prerequisites or
duplication of nursing course
content required for licensure
Permanence/
Sustainability
Implied
EDUCATION
FOCUS
Post-ADN/RN Licensure
Concurrent ADN-BSN
50%
40%
30%
20 50%
28 40%
17 48%
20%
10%
0.5 7%
0%
Caucasian
Hispanic
African
American
Asian
 Languages include Spanish, Vietnamese, Korean, Cambodian, Tagalog,
Mandarin, French, Cantonese, Russian, Hindi , Armenian and more than
20 others
Total Population (All Races) = 9,963,789
1.5%
White, non
Hispanic
Black
48%
27%
Asian
Hispanic
14%
9.3%
American Indian/
Alaskan Native
 Language other than English spoken at home, % age 5+, 2006-2010 = 56.4%
 Spurred by AB 1295 and CSU’s Chancellor’s Office
 Encouraged by CINHC and California Collaborative
Model of Nursing Education
 Further impetus- IOM report and goals related to 80%
BSN workforce by 2020
 Planning for past two years- working out common prerequisites, curriculum and timing of course offerings
 Pre-requisites at Community College
 Admitted to Nursing program at CC
 Summer between two years of nursing at CC at
CSULA Extended Ed
 Summer after completion of ADN -Pass NCLEX,
Courses at CSULA Ex Ed
 Begin last year of BSN at CSULA Fall- Summer
 Roadmaps for each school on website
Roadmaps
 Collaborative details- timing, portfolio content
 Coordinator
 Recruitment
 Advisement (financial and academic)
 Implementation
 Reporting
California welcomes the first cohort of students in the APIN Program!
Cohort 1: 69 Students
8
9
Cerritos
Glendale
12
12
ELAC
Long Beach
Los Angeles City
10
9
9
Pasadena
Rio Hondo
Cohort 1 Race and Ethnicity
10%
9%
3%
29%
Caucasian
Hispanic
20%
Asian
28%
Filipino
Two or More Races
Other Race
17%
Male
100%
30%
Bachelor’s
80%
60%
83%
Female
40%
70%
No degree
26%
Non-Native
English
74%
Native
English
20%
0%
Gender
Previous Degree
Language*
 Non-Native Languages:
▪
▪
▪
▪
Armenian: 2 students
Cantonese: 2 students
Khmer: 1 student
Korean: 1 student
Russian: 2 students
Spanish: 5 students
Tagalog: 2 students
Vietnamese: 3 students
T-Shirt
 Facebook Page
Officers
Take Home Tools
 Use and enhance existing practices
 We built upon an existing collaborative model
and developed it to fit our program needs
 Value CC educational foundation to meet RN
workforce needs
 Build and foster relationships
 Open lines of communication
 Availability
 Inclusion
 Response
41
Take Home Tools, cont.
 Common vision
 We all held the same vision of achieving the BSN
within 1 year of ADN graduation.
 Secondary vision was ADN program
improvement and greater student success that
would result from this relationship
 Participants identified as “Partners”
 Support / Approval
 Campus, State, Regulatory agencies, employers
42
Take Home Tools, cont.
 Collaboration
 Partners make collaborative decisions with
CSULA for all critical program elements
 Individual ADN programs maintain
authority for their students
 Evaluation per collaborative admission
criteria
 Selection
43
Take Home Tools, cont.
 Transparency
 Critical program elements, including funding status, are
communicated to our partners

No mystery
 Respect
 Value of our partners is recognized and demonstrated by
their participation in program development, revisions,
implementation, etc.
 Student involvement
 Students are viewed and respected as partners
44
Take Home Tools, cont.
 Don’t re-invent. Re-kindle.
 Find your Champions.
 Build a trusted team.
 Always keep the “prize” in sight.
 Be flexible
 Recognize and acknowledge when something is not
working

Change it. Learn from it.
45
Take Home Tools, cont.
 Enjoy
Always maintain
a sense of humor!!
46
shared resources
diversity and inclusion strategies
inform and engage
creative partnerships
early start to future
new options
idea generation
seamless education pathways
transferrable strategies
sustainable plans
47
 Foster academic partnerships to streamline progression,
increase shared capacity across academic entities and
programs, with access or plans to continue education.
“Early Start” – Start or complete pre-requisite coursework
essential to next level of education as part of current
education plan, with course credits for transferability.
Inform, interest and engage all students in academic
progression options to strengthen career mobility.
48
Utilize data on population based health disparities,
medically underserved areas, and provider shortages to
guide and fund priorities for action.
Adopt diversity and inclusion strategies to align the
healthcare workforce with the population - engage
interest with ethnic minorities, conduct early outreach,
strengthen academic success, provide mentoring, financial
support.
Provide or strengthen employer partnerships and
support including financial (tuition reimbursement,
stipends), professional (potential employment, career
advancement), and other (flexible scheduling)
49