DATE:  August 13, 2002

TO:  Montana Board of Regents

FROM:  Joyce A. Scott, Deputy Commissioner for Academic & Student Affairs

RE:  Nursing Analysis Progress Report

The Deans and Directors of Nursing met with me on Monday, July 22, 2002 at the Higher Education Complex in Helena. Our purpose was to review the Regents Decisions about Nursing Programs for the May Meeting, to discuss the question of nursing program capacity, and to collect input about the Decision Points.

Participants considered RN program capacity and excluded BSN completion programs because these require the student be a licensed RN to enroll. I have since done a similar analysis for LPN capacity via email and telephone consultation with LPN program directors statewide.

Program Productivity. Table I illustrates RN program graduates statewide since 1993. The numbers stricken under MSU-Northern and Salish Kootenai College represent graduates of BSN completion programs, who were already counted in earlier RN completions and do not add to the total RN pool. Table III reports LPN completions since 1993. In both the RN and LPN programs, comparison of completion data and current capacity figures shows that not all programs have been graduating the optimum number of students every year.

Projected Capacity. Table II shows the current capacity of RN programs in the third column. Present sites are identified beside the campus name. Notes on this section include explanatory information offered by program directors. The column on the far right captures program directors projections of capacity under the conditions noted (i.e., pending grants, State Board of Nursing approval, resource acquisition, etc.). Table IV serves the same purpose for LPN programs

Attrition. At the bottom of Tables II and IV, I have noted total slots available and have introduced an attrition factor. Attrition occurs for several reasons. Often, it is a result of poor academic preparation. Nursing program leaders recognized that the attrition rates vary by program type, from year to year, and according to the cohort admitted. Leaders agreed that the twenty percent figure (20%) was a reasonable average. However, RN directors think that stronger academic preparation can increase retention and so have raised academic standards for RN admission to improve student retention.

Outcomes. The calculations show, with the recent addition of the 40-seat ASN at Tech, current capacity is approximately 263 RN s per year after attrition. Proposals for increasing RN slots could result in as many as 410-430 RN graduates per year, or 330-350 after attrition. If campuses can reduce attrition, the State could see a substantial gain in RN graduates.

All RN program capacity in Montana depends on the availability of clinical slots for students clinical training. Several communities are limited in the number of such placements. The expansion of existing programs or the addition of new programs must address this factor.

For LPN programs, Table IV shows a current capacity of 190 students or 154 completions after attrition. Projections suggest that it is feasible to increase to 176-196 after attrition. The quandary here resides in the differences between state projections for workforce demand (lower) and the experiences of practitioners who report a much stronger demand (higher) that the state s data would suggest.

Other Factors at Play. Nurse educators believe many factors beyond program capacity affect the State s ability to recruit and retain nurses. A growing number of Montana nurses are seeking employment out of state, and many nurses have left practice before retirement and will not return.

Workplace Conditions. Deans/directors report that work conditions may interfere with recruiting and retaining nurses. Specifically,

  • Montana salaries are inadequate, below regional/national averages for comparable work;
  • In some facilities, nurses are not shown respect commensurate with their education or role in the health care system;
  • In some facilities, nurses may not be allowed the autonomy afforded other professionals in the health care setting;
  • The combination of heavy workload and the increasing acuity levels in patient care make nursing especially stressful.

Several Montana health care agencies are meeting staffing shortages by importing nurses from out-of-state and/or out-of-country, paying premium wages and benefits to do so. Colleagues suggest that such funds might be better invested elsewhere to stabilize the Montana workforce:

  • Supporting local students to complete nursing studies;
  • Providing nursing graduates with loan repayment options in exchange for years of work;
  • Establishing scholarships tied to employment with the sponsoring agency for 1-3 years after graduation.

Faculty Availability. Qualified faculty are scarce. MSU-Bozeman is seeking to provide program options at the Master s level for faculty training. In larger population centers, nursing faculty may be hired away from a campus by local hospitals with much better salary scales.

Nurse educators see faculty union contracts as a potential problem because they may set a ceiling for faculty salaries that is not be competitive for nurses who are recruited nationally pool. Finally, educators suggest retired nurses to fill in vacancies in faculty positions, but state retirement regulations may impede this. .

Conclusions. RN programs in the State produce a good number of graduates. Directors have planned responsibly to expand capacity over the next few years. Nursing directors are sensitive to attrition and will work to select better-prepared students who are more likely to graduate and complete the licensing examination.

For LPN programs, there is a good prospect of turning out more graduates within present resources and availability of clinical opportunities. Expansion of RN and/or LPN programs in any one setting, however, will depend on the availability of adequate clinical settings. Clinical training requires a certain patient base and range of patient illnesses.

Any expansion beyond the levels indicated in the attached Tables will require further detailed study because it is uncertain that clinical capacity in targeted communities will be sufficient to provide the kind of educational experience required for complete RN and LPN education.

 

Pc:       Commissioner Crofts
Ms. Barbara Swehla
Nursing Deans and Directors
Chief Academic Officers