In Oregon, Collaboration Key to Nurse Education

Across the country, groups of nurses, educators and other experts have been coming together to tackle a growing shortage of nurses. Many of them have never worked together before, but like a community facing a cresting river, they are getting organized and filling the sandbags. This kind of all-hands-on-deck coordination has been happening since 2002 at the Oregon Center for Nursing (OCN) where individuals and organizations representing nursing, education, hospitals and other employers are assessing the shortage and finding ways to build the nurse workforce Oregonians need. Oregon is also one of 30 states with a team of nursing experts supported by the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation, whose mission is to ensure all Americans have access to a highly-skilled nurse, when and where they need one.

The Oregon Center for Nursing’s motto is “Because Oregon's Health Depends on It,” and with good reason. The Beaver state faces a 20% shortfall in nurses to care for Oregonians in the coming years. The baby boomers are growing older nationwide, and in Oregon that means already half a million people are 65 or older, and that number will grow to one million by 2025, making seniors a quarter of the state’s entire population. At the same time, half of Oregon's registered nurses are 50 or older, and by 2025, 41% of them will likely retire; even in the current nurse workforce, too few have education beyond a two-year degree, especially in the state’s many rural communities. Further complicating the problem are the increasingly central and complex roles nurses play in contemporary patient care, particularly the care of older Americans. The current nursing workforce in Oregon, as elsewhere, does not have all the skills to meet the needs of an aging population with changing and often complex health care needs – which they are increasingly receiving in non-hospital settings. Legions of new, well-educated nurses will be necessary to provide quality, accessible primary and preventive care, chronic care management and care coordination that also keeps waste and costs down.

“The numbers in our state are pretty grim,” says Kristine Campbell, PhD, RN, OCN Executive Director and leader of the state’s CCNA team, “but they have really galvanized us into a mission-focused team.” According to Campbell, strategic and concrete goals laid out early in the process guide her and her colleagues and keep everyone moving forward on a wide range of initiatives designed to educate more nurses with superior skills who can meet Oregon’s health care needs into the future.

Campbell will tell you that at the heart of all this collaboration is trust, and she offers a favorite example. Oregon has 21 educational institutions with nurse education programs and, like many schools, these programs compete for students, faculty and resources. However, because expanding education capacity is central to solving their problem, Oregon needed to know how much more capacity was necessary, and that meant they needed good numbers. OCN persuaded all 21 schools to provide detailed data about their applicant pools, and made an important discovery: while they’d believed there were five applicants for every one slot in Oregon’s nursing schools, it turned out there are only two or three aspiring nurses for every opening once duplicate applications are accounted for. Armed with this revised figure, Campbell and her colleagues are now pursuing realistic proposals to increase faculty and resources that more precisely match the student demand.

Nurse education programs are working together in other ways, too. After several years of hammering out the details, the Oregon Consortium for Nursing Education, a partnership of eight community colleges and the five Oregon Science and Health University campuses, now share a single admission standard for all undergraduate nursing students. The uniform admission standard lifts logistical and financial obstacles for applicants, and it also means, as Campbell explains it, “once you’re in, you’re in. If you start at the Portland campus but then move to Coos Bay in the 3rd Quarter of your junior year, you move right in to that program – and your financial aid follows you.”

Campbell is happy to talk about some additional cooperative efforts among schools and other organizations in her state. For instance, through the Consortium, the same schools that share an admission standard also have standardized their curricula. This ensures that graduates at all levels are equipped with the skills and competencies they need to deliver the best health care to Oregonians, and it also allows more nurses to earn a four-year degree through course work at a more accessible campus. Campbell and her colleagues are especially proud of StudentMAX®, which began as a Portland/ Southwest Washington area collaboration among hospitals and nursing schools and now, as a licensed software product, is facilitating placement of students in clinical settings and ensuring high educational standards around the country. And, importantly, there are the many organizational partners demonstrating the value of investing in nursing for the public good and seeking legislative support to expand nursing faculty and increase their salaries. According to Campbell, their work “is all about the mission, and it’s simply because we’ve all set our sights on these shared goals that we’re making such tremendous progress.”
That can-do, collaborative approach has made Oregon a model for states and regions across the country, and CCNA is helping make sure that model is widely shared. Through strategic partnerships, state teams like Oregon’s are implementing changes to nursing education, advocating for policy changes, and addressing faculty shortages all to increase nursing school enrollment and bring more nurses into the workforce. The teams are comprised of representatives from nursing education, state workforce offices, state departments of labor, consumers (often AARP state offices), local business, philanthropies, and others. CCNA provides ongoing technical assistance to help teams accomplish these critical tasks and fosters collaborative learning experiences that link the teams and allow them to share best practices and lessons learned with their peers in the other states. “The CCNA model is our model,” says Campbell. “We talk to each other, complement each other’s work and help each other. That’s how we’re going to reach our goals.”