Blog

By
 - Susan Reinhard, PhD, RN, FAAN, Senior Vice President and Director, AARP Public Policy Institute; Chief Strategist, Center to Champion Nursing in America
 - Brenda Cleary, PhD, RN, FAAN, Director, Center to Champion Nursing in America

Note: This perspective was originally published in the November 2, 2009 edition of Community College Week.

In light of the work of the RWJF Initiative on the Future of Nursing at the IOM and its upcoming February Forum on the Future of Nursing: Education, we feel it is important to highlight the innovative approaches to redesign nursing education being implemented across the country by the Center to Champion Nursing in America (CCNA) and our 30 state teams across the country.

The United States faces a nursing shortage, perhaps like none we’ve experienced: by 2025, the shortfall in registered nurses is expected to reach 260,000, according to Dr. Peter Buerhaus of Vanderbilt University. And, as baby boomers age and require greater attention and care, this shortage poses a growing threat to the quality and availability of health care services in our system.

This shortage is not due to a lack of qualified aspiring nurses. In fact, would-be nursing students are flooding admissions offices with applications every year; there is simply no place for them to go.  In 2008, almost 99,000 qualified applications were turned away by U.S. nursing schools, according to the National League for Nursing.

We do not have enough nurses, in part, because of systemic problems in nursing education in the U.S. In order to stem the tide of this shortage, colleges and universities need to be equipped to graduate tens of thousands of additional nurses each year.  This is no small feat. The current system is beset by too few faculty, a lack of strategic partnerships between community college and university programs, and insufficient clinical sites to provide the hands-on experience that is required for competency development. 

To address these specific challenges in nursing education, the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation, is working with 30 state teams across the country to redesign the system to enable new graduates to enter the workforce with the skills they need to serve patients in hospitals and long term care facilities as well as in the community, and to become faculty members themselves. The Center seeks to spread best practices from around the nation that are ensuring the best in clinical education, as well as sharing innovative approaches to building the teaching capacity in nursing schools.  In late 2009 in Portland, Ore., the Center brought together teams of nurses and other leaders from 11 states to demonstrate how they are addressing these challenges.  The Oregon Consortium for Nursing Education (OCNE) was co-host of the conference and a featured model program, considered one of the most innovative nursing education redesign approaches in the country.

Oregon was one of the first states to respond to this critical need to redesign nursing education. Formed as a part of the state’s 2001 strategic plan to combat the nursing shortage, OCNE is a unique statewide partnership that includes faculty from eight community colleges and Oregon Health & Science University School of Nursing. As a part of its charge, it created a shared curriculum for nurses based on necessary core competencies. All consortium campuses teach the same courses, helping students move seamlessly from Associate’s degree to Bachelor’s degree programs, without having the take additional prerequisites, thus decreasing the time needed to graduate and begin direct patient care. 

All of the Oregon consortium members have increased enrollment in their programs, and greater numbers of nursing students are opting to pursue higher-level degree programs. At Rogue Community College in Oregon, for example, enrollment has nearly doubled, according to Linda Wagner, the head of the college’s nursing department.  During the first year that associate degree students had the option to continue on in their program, some 22 percent chose to pursue their Bachelor’s; this year, that number had risen to 44 percent. 

Perhaps most beneficial to the state is that these new nurses who graduate all have the skills required to care for an aging population, whether they obtain a bachelor’s or an associate’s degree. The end goal is to increase both the number and skill level of new nurses to manage the needs of the 21st century patient in a reformed U.S. health system as well as to create a pipeline for the faculty that are desperately needed by all levels of nursing education programs.
 
In California, as well as Oregon and other states, many aspiring nurses have faced roadblocks in finding the necessary clinical education necessary to meet their degree requirements. The state’s shortage is expected to reach 109,00 next year, yet current rates of graduation will only produce half the required number of new nurses to fill the gap. Thus, the state has recently implemented the Centralized Clinical Placement System (CCPS), a web-based tool that is streamlining the clinical placement process, helping nursing students secure rotations in hospitals and other previously untapped medical facilities.  So far, the system has helped increased Bay Area nursing student enrollment by 47 percent over the last five years.

To be sure, combating the nursing shortage and building a 21st century nursing workforce is not solely the responsibility of educators. However, we do know that within the education system, there are deliberate steps we can take to ensure that greater numbers of students enter the workforce with the skills they will need to succeed in this ever-changing health care landscape. The more we can work together and learn from each other – across communities, states and the nation – the more likely we are to reduce the nursing education bottleneck and create a nursing workforce ready to care for today’s patients and for generations to come.  

When the Center to Champion Nursing in America (CCNA) was launched in 2007, the top priority for us was expanding education capacity for nurses.

With the need for improving access to affordable and quality care for all Americans becoming more urgent each day, getting more nurses into the career and teaching pipeline was—and still is—an urgent challenge. Because education and workforce development in any field are generally coordinated locally, we immediately went to work supporting state level efforts to help grow a highly trained national nurse workforce.

What’s happening in states around the country is the subject of the second in an exciting series of articles appearing in the American Journal of Nursing (AJN) called “Uniting States, Sharing Strategies.” The first article in the series discussed the major messages that emerged from two national summits on education capacity with state teams of stakeholders; the current article, The Technical Assistance Program of the CCNA: How a national organization is helping to expand nursing education capacity state by state, drills down into the nuts and bolts of CCNA’s work with 30 state teams. The remaining articles will look in depth at five states that are exemplars in redesigning and expanding nursing education.

As someone who’s spent much of my career working at national and state levels to address the inequities in access to, and the quality of, health and long-term care, I am so pleased to see this article in print and share it with our CCNA blog readers. I have directed national initiatives that provided states with incentives to help consumers of all ages live in their homes and communities and still receive quality health care. As director of a national technical assistance center created to assist states and U.S. territories re-design their long-term care systems, I know first-hand the importance of sharing strategies, and CCNA is well positioned to serve as a conduit for this technical assistance program as we work to support expanding education capacity for nurses. In this article, my co-authors (and valued colleagues) and I detail CCNA’s efforts to support 30 geographically diverse state teams in expanding nursing education capacity through our Technical Assistance Program. The program is designed to support states that are finding solutions to their nurse shortage, and help other states adapt and build on the experiences of those that have found success.

From the rigorous process of selecting the original 18 lead state teams to site visits, evaluations and the all important mechanics of facilitating communications among the 30 teams, this article describes how CCNA is implementing its vision of a national movement to increase awareness of the need to expand nursing education capacity and support the changes required for success.

By Jim Walker, CRNA, DNP, President, American Association of Nurse Anesthetists

After 16 years as a Certified Registered Nurse Anesthetist (CRNA), I’m still caught off guard whenever a patient or colleague says to me, “I didn’t know nurses can give anesthesia. Is that something new?” But I’ve come to recognize these awkward moments as golden opportunities to educate the public about the important contributions of nurse anesthetists.

There are probably a lot of reasons why many people, even some in health care, don’t have a good handle on nurse anesthetists. It’s certainly not for lack of trying to spread the word by the nation’s 40,000+ CRNAs and student nurse anesthetists, as well as the American Association of Nurse Anesthetists. More likely it has to do with the fact that much of our quality time with our patients is spent preparing them for their procedure—while they are asleep or semi-conscious—and while they’re recovering from the procedure. Sometimes the message “I’m a Certified Registered Nurse Anesthetist and I’ll be giving you your anesthesia today” registers, and sometimes patients are just too distracted to care. However, what patients do care about is that we will keep them safe, comfortable, and pain-free, and that we will stay with them throughout their procedure. That message always resonates.

Another reason many people aren’t clear about the role of nurse anesthetists is the misperception that giving anesthesia is the province of physicians.  Actually, nurse anesthetists were the first anesthesia professionals, dating back to the Civil War. Today we are the hands-on providers of more than 32 million anesthetics each year, providing anesthesia in every setting and for every type of case in which anesthesia is required. The operative word here (no pun intended) is “hands-on”; more often than not it’s a CRNA who actually delivers the anesthesia and stays with and monitors the patient. We (CRNAs) are great at what we do because we do a lot of it.

We have the incredible responsibility of providing vigilant one-to-one patient care daily and protecting and advocating for patients during their most vulnerable moments… and after which, we make sure they are delivered safely into the capable hands of other health care professionals in the recovery room. It is making this daily "routine" patient-centered that makes being a CRNA so intensely satisfying on a personal and professional level. 

During the week of January 24-30, nurse anesthetists across the country will celebrate their profession and anesthesia patient safety during the 11th annual National Nurse Anesthetists Week. You can learn more about us at www.aana.com.

In 2009, health care reform was the most widely discussed issue in the United States because it affects every single American in every corner of the country. Whatever shape final legislation in Washington might take, we can expect greater numbers of Americans seeking primary and preventative care and, regardless of reform, greater numbers of older Americans seeking care as the baby boom generation matures. Combine these factors with technological and other transformations in health care delivery and it becomes clear that nurses and the nature of the nurse workforce have never been more important.

The U.S. will face a shortage of as many as half a million nurses by 2015; there are roughly 140,000 unfilled nursing positions in hospitals and nursing homes combined; half of all nurses are planning to retire in the next 15-20 years just as a nation of baby boomers will put unprecedented demands on the nation’s health care system. And scores of studies demonstrate that when it comes to hospital patients, the more nurses on staff, the better the health outcomes and the lower the mortality rates—a fact that affects every American family.

But numbers are only part of the story. We know the importance of a nurse workforce with the skills required by a reformed health care system to serve the Americans who will be using it in ever greater numbers. Nurses occupy an increasingly central role on care delivery teams and they can and should have a more prominent role in the delivery of primary and chronic care management. There is abundant evidence that advanced practice nurses provide high quality—and highly affordable—care in areas where no regulatory barriers limiting their practice.

As the health care workers who spend the most time providing medical care, nurses must also have more advanced education and skills. This is why we devote so much attention to ways of expanding nurse education to create a pipeline of new nurses—and nurse educators. Faculty shortages, limited clinical sites and even classroom space resulted in nearly 100,000 applicants being turned away from nursing schools last year—qualified applicants who want to devote their careers to caring and advocating for patients. While there are innovative solutions to the education crunch being implemented around the country, expanding education will most certainly require increased funding. We have worked hard to make this happen.

We believe that every American deserves a highly skilled nurse when and where nursing skills are needed. A richly skilled, effectively integrated nursing workforce—with enough professionals to meet the need—is essential to delivering high-quality health care. We will continue to act as an information resource on health care reform. The Center is collaborating with our AARP colleagues to advance the roles of nurses in increasing access to primary care, transition care and chronic care management in a reformed health care delivery system.