Nursing Issues
DATE: May 1, 2002
TO: Montana Board of Regents
FROM: Joyce A. Scott, Deputy Commissioner for Academic and Student Affairs
RE: Emerging Issues in Nursing--Revised and Updated
The following updated report is designed to inform the Board about program discussions currently underway around the state. I consulted with several colleagues in nursing but may not have mastered all details and complexities at play. Errors of fact are my responsibility.
In October, I was appointed to the Governor's Task Force on Health Care Workforce Shortage and to its Data Subcommittee. Subcommittee members are working on supply and demand data for all health care fields--including nursing--and state demographic projections. The Task Force will make its recommendations to the Governor around September 1, 2002.
In this context, the national discussions about health care needs, and a recent meeting of the MINT (Montana Initiative for Nursing Transformation, a spin-off of the MUS Nursing Task Force whose report the Board endorsed four years ago), I have learned of many aspirations for nursing education. For the Board's information, I offer a summary below.
Existing Nursing Programs are at five levels--certified nurse assistant (certificate), AAS (LPN authorized for upgrading from a certificate in July 1998), the ASN (2-year RN), the BAN or BSN (4-year degree offered in two formats as generic and completion), and the MS or MSN. Among the bachelor's degrees, a generic program begins at freshman level and terminates with a baccalaureate degree in nursing whereas a completion program begins with an ASN and RN licensure and terminates with the baccalaureate degree in nursing.
Masters: Montana State University-Bozeman (with options in specialty areas)
Bachelors: Both Generic and Completion 4+ outreach:
Carroll College (generic)
Salish Kootenai College (completion)
MSU-Bozeman (generic) [serving Bozeman, Billings, Great Falls, Missoula, and a cohort
Program from Missoula-based faculty to Kalispell]
MSU-Northern (completion) [Internet statewide]
Associates: Leading to Registered Nurse licensure (ASN) 4:
Salish Kootenai College
Montana State University-Northern [serving Havre, Great Falls, Lewistown]
Montana Tech CoT
Miles Community College
Leading to Licensed Practical Nurse licensure (AAS) - 5:
CoT's at Billings, Great Falls, Helena, Missoula and Montana Tech
CNA: Montana Tech and some high schools
Outreach: Historically, MSU has provided nursing education to communities around the state.
Montana State University-Bozeman has had upper-division programs in Billings, Great Falls, and Missoula and closed a similar program in Butte in 1985 for lack of student numbers. Bozeman also provides nursing outreach in Kalispell under a cohort arrangement involving FVCC. MSU-Bozeman's comprehensive, statewide generic program is 10th largest in the country.
MSU-Northern offers the ASN via NorthNet and onsite instruction in Havre, Lewistown and Great Falls. The BSN completion program [only for students with the 2-year RN + RN licensure] is available via Internet wherever students are located around the state.
New Programs Contemplated: There is discussion around the state about adding new nursing programs. Below, I summarize what I have learned so far.
MSU-Bozeman, -Great Falls and -Northern are studying feasibility and planning together to provide distance delivery of nursing education to rural North Central Montana.
MSU-Bozeman is studying the feasibility of an upper-division program in Bozeman now that the community has grown sufficiently to support the clinical component.
Miles Community College has a proposal going to FIPSE for an LPN-ASN program to be offered in Billings, Helena and Missoula in cooperation with the local CoTs in those towns.
The Board of Nursing denied a proposal by Miles CC to extend ASN to Glasgow, Sidney and Glendive.
Tech will provide its Certified Nurse Assistant program by distance delivery to the state.
Helena CoT: ASN (2-year RN)
FVCC: ASN (2-year RN) in long-range planning discussions at FVCC but this need may be met in the short-term by the MSU-delivered BSN cohorts.
TECH: Reorder two existing Associate degrees and add bachelors degree
2-year AAS (LPN)
3rd year ASN (2-year RN)
4-year BSN *
UM-Missoula: BSN
*When the Regents approved the ASN at TECH, the campus said it would work with MSU-Northern
to bring the BSN completion program (last two years) to Butte.
Workforce Supply and Demand: Several studies of workforce needs are available or underway, and supply-demand will be a central issue for the Board to consider. The attached degree completion chart gives one part of the data (Appendix A). I am seeking more data from professional associations and national organizations. We will review the data carefully and talk to campuses about their productivity. There is a need for an assessment of existing and potential additional capacity, if any.
A Montana Department of Labor[1] report shows 2,384 LPNs in 1998 and projects need for 2796 in 2008, for an increase of 412 or 17.3 percent. Average annual openings are 41 for growth and 51 for replacements (steady state). For Registered Nurses, there were 6850 in 1998 and a projected need for 8148 in 2008, for an increase of 1296 or 18.9 percent. Estimated annual average replacements are 113, with an estimated 130 new positions per year. These are summarized at Appendix B.
Other Factors: There are several other factors that the Board may wish to consider.
1. In July 1998, the Board accepted a report from the MUS Task Force on Nursing Education for the 21st Century (Summary at Appendix C) and asked that group to proceed with implementation. In the intervening four years, only the first two recommendations have been adopted, and articulation continues to be a problem.
2. The MINT group brought in a consultant from the Robert Wood Johnson Foundation on February 12-13 to advise on articulation. Dr. Mary Rapson advised the group that the LPN at the AAS level is "over-educating" students and creating excess credit problems for them. Graduates at each level are getting too much of the same thing (emphasis mine). Dr. Rapson further commented that a typical PN of 42-50 credits would suffice and fit within a 2-year RN at 72 total credit hours.
3. Based on the Rapson consultation, the MINT group has drafted an articulation model, which has been resolved at a recent meeting in Missoula.
4. Since Montana Tech converted its LPN to the AAS and implemented the 2-year RN (ASN) that the Board approved in 1999, the campus has learned from the National League of Nursing (NLN) that NLN will not accredit two associate degrees that lead to two separate licenses at the same institution. Thus, only one of the two 2-year degrees can be accredited.
5. When Montana Tech requested approval for the 2-year RN, the campus said it would work with MSU-N to bring in the BSN completion program for those students wishing it. To date, no progress has been made.
6. Montana Tech's "ladder" concept linking the LPN and ASN requires a student to complete 118 credits, excessive by 46-48 credits for an associate degree.
7. According to the deans of nursing, the state lacks sufficient clinical facilities to support clinical training for substantially larger 2-year RN or generic BSN populations. Only due to recent growth in Bozeman community can MSU consider an upper-division program there.
8. LPN programs in the state are "accredited" by the State Board of Nursing but not by external professional bodies such as the NLN. The State Board is contemplating a rules change to require external accreditation of all nursing programs by 2007.
9. One indicator of program quality may be found in graduates scores on the N-CLEX, the national licensure examination. The campus performance on this examination is summarized at Appendix D.
Recommendations: In view of the many unknowns and complexities, staff would recommend:
That the Board delay accepting and deciding on new nursing program proposals until the Governor's Task Force has made its recommendations.
That the Board require LPN→ASN→BSN or LPN/ASN→BSN course Articulation Contracts be adopted and published statewide by all nursing programs prior to considering new ones.
That completed Articulation Contracts showing how and how much credit students can transfer among programs accompany all new program proposals.
That the Board invite Montana Tech to decide which of its nursing associate degree programs to phase out and which to accredit.
That the Board invite nursing educators to consider whether the university system should continue the LPN at the AAS level or go back to a certificate? With response by September.
That the Board ask OCHE to conduct formal assessment of 1) Unused capacity in existing nursing programs (PN and RN), and 2) Expanded capacity of existing programs with additional support.
That the Board ask OCHE to work with MSU to "subscribe" to or acquire on-line courseware already created and in use at other institutions [see Western Consortium for Educational Telecommunications] to increase access and avoid wasteful redundancy and duplication.
That the Board ask OCHE to prepare 1) an analysis of nursing program costs per student as compared to actual revenue available in the allocation model and 2) an analysis of the fiscal impact of proposed new nursing programs on existing campus budgets.
Thank you for your consideration.
cc: Commissioner Crofts, Presidents, Chancellors, CoT Deans
Academic Officers, Nursing Deans/Directors
Attachments:
Nursing Degree Completions
Department of Labor and Industry Workforce Projections
Executive Summary of Nursing Task Force Report
NCLEX Pass Rates for Montana
New MINT Articulation Model
[1] Job Projections for Montana's Industries and Occupations, 1998-2008. March 2001, Research and Analysis Bureau, Job Service Division, Montana Department of Labor and Industry.