Community Colleges, Universities Collaborate to Support a Stronger Nursing Workforce

After a brief stint in local politics, Justin Gill decided to join a profession he found more fulfilling: nursing.

He earned his associate’s degree at a community college in Washington, where tuition was lower than it would have been at an area university, and then transitioned into a nearby RN-to-BSN program that enabled him to earn his bachelor’s in one year while working full time as a nurse.

He wouldn’t have been able to advance his education so quickly, so seamlessly, and at such a low cost, he says, had it not been for the partnership between the community college where he earned his associate’s degree and the university where he is now completing his baccalaureate.

And for that, he is very grateful.

“It not only has provided me with the tools to be a better nurse, but it has opened many doors for the future,” said Gill, who plans to earn his master’s degree next year.

Gill’s story shows how community colleges and universities can work together to help nurses advance their education so that they can better meet the needs of an increasing, and increasingly complex, patient population. That is the goal of the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is rooted in a 2010 report from the Institute of Medicine (IOM). It recommends that 80 percent of nurses hold bachelor’s degrees (BSNs), or higher, by 2020.

The IOM committee said nurse academic progression is imperative to fill gaps in teaching and public health, to increase the number of advanced practice registered nurses, and to encourage nurse leadership. There also is a need for more PhD-prepared nurses to conduct science and discovery, the IOM said.

There has been debate about the 80 percent BSN goal. Some educators worry that putting a premium on nurses prepared with baccalaureate and higher degrees will reduce employment and other opportunities for nurses with associate’s degrees, who tend to be more racially and ethnically diverse than BSN-prepared nurses and who often practice in underserved areas. But the Campaign for Action recognizes that community colleges are essential because they create more accessible and affordable opportunities for students, especially those who work, have family obligations, and who are unable to move to attend four-year institutions.

Nurses prepared with associate’s degrees play a critical role in the health care system. In 2011, three in five nurses (59.7 percent) who took registered nurse (RN) licensure exams for the first time did not have bachelor’s degrees, according to data released last week by the Health Resources and Services Administration. The majority of non-bachelors-prepared RNs earn associate's degrees in nursing (ADNs) at community colleges, while others attend hospital-based nursing diploma programs. Licensed practical nurses (LPNs) take separate licensure exams.

“Community college nursing programs are essential to the nursing profession, to health care and to the country,” said Donna Meyer, MSN, RN, president of the National Organization for Associate Degree Nursing. “However, with a changing health care delivery system, technological advances, and the need for more care coordination, academic progression is imperative. The nurse faculty shortage and the need for more advanced practice nurses only intensify the need. I am optimistic because community colleges and universities are working collaboratively to promote academic progression for all levels of nursing.”

Working Together

Indeed, community colleges and four-year academic institutions can, and are, working together to support academic progression and find innovative solutions to strengthen nurse education in ways that benefit nursing students and the patients they eventually serve.

In New Mexico, for example, Nisa Bruce, MS, RN, director of nursing at San Juan College in Farmington, a community college, and Jean Giddens, RN, PhD, FAAN, professor and executive dean at the University of New Mexico College of Nursing and an RWJF Executive Nurse Fellow (2011-2014), are helping to lead such change. “We are so much stronger together than we have been in our isolated communities,” Bruce said.

That spirit of collaboration got a major boost in 2012, when five key organizations representing community colleges and nursing education issued an historic joint statement in favor of creating new academic pathways for nursing students. Also that year, RWJF launched an initiative that provides up to $300,000 over two years to groups of nurse leaders and champions in nine states that are making headway on academic progression.

“The Robert Wood Johnson Foundation is committed to engaging with community colleges in our work to strengthen nurse education, and we will continue to seek input from them as we work to promote a more highly educated nursing workforce,” said RWJF Senior Vice President John Lumpkin, MD, MPH.

RWJF Senior Adviser for Nursing Susan B. Hassmiller, PhD, RN, FAAN, who got her start in the profession at a community college, added: “We see partnerships between universities and community colleges as absolutely essential to achieving higher levels of education for nurses.”

Signs of Progress

Among the nine APIN grantees are initiatives in Washington state, New Mexico, and Texas (see Spotlight, below).

In Washington, nurses and nurse allies are working to develop a smoother path to a BSN through shared and streamlined curricula, support systems for minority students, and direct transfer agreements between community colleges and universities. They are also working to increase the number of RN-to-BSN completion programs and the number of colleges offering the BSN.

“It’s really about increasing access for our students so they can continue on that path and gain those more complex skills that are needed for health care today,” said Jenny Capelo, MAE, RN, dean of Allied Health at Wenatchee Valley College in Wenatchee, Wash.

For community colleges, forging new partnerships with area universities is not without challenges, she said, citing difficulties at Olympic College, which recently launched a fully accredited RN-to-BSN program developed in partnership with the University of Washington-Tacoma. The college had one year to design and start the program, which put a tremendous burden on faculty. Finding enough qualified nurses to direct and teach the program was also difficult, she said.

But Olympic College and the University of Washington-Tacoma found ways to make it work, in part because they shared faculty, and had support from their administrations and the financial backing to create a quality program.  

Strong relationships were another key factor, Capelo said. “When we come together, we are all educating a bachelor’s-prepared nursing student. That is our task, and that’s the changing landscape of nursing education.”

Strong Partnerships

Strong partnerships have also been critical in New Mexico, where nurse leaders are working to implement and evaluate a statewide nursing curriculum delivered through university and community college partnerships. The goal is to offer baccalaureate education in any community that has a nursing program.

To achieve that goal, Bruce and Giddens, along with deans and directors from across the state, are working to create partnerships so community colleges can offer two tracks for nursing students: one that leads to the associate’s degree in nursing, and a second, in collaboration with a state university, that leads to the bachelor’s.

Students won’t be the only beneficiaries; faculty and academic institutions will also benefit from a consistent approach to nurse education, shared resources, and more universal access to the state’s rich well of nursing expertise. “We’re all affiliated with a university or a college that writes our paychecks, but in truth I think we see ourselves more as faculty of the state,” Giddens said.

Spotlight

The Texas Team’s Approach to Academic Progression

Texas offers another innovative, promising model that demonstrates how universities and community colleges can work together to help nurses advance their education in order to better meet the needs of a growing, and more complex, patient population.

In Texas, nurses and nurse champions are implementing seamless articulation pathways for nurse academic progression by increasing the standardization of the general education courses in RN-to-BSN programs to help nurses obtain BSN degrees. The seamless articulation pathways will be a “win-win” for community colleges, universities, students and, most importantly, patients, according to Helen Reid, EdD, RN, provost at Trinity Valley Community College, and Kathryn Tart, EdD, RN, founding dean and professor at the School of Nursing at the University of Houston Victoria.

Currently, many community colleges offer nursing students a “2+1+1” pathway, in which students take two years of nursing to earn their associate’s degrees. If they want to earn bachelor’s degrees, they take one year of general education coursework and a final year of nursing courses.

But that model doesn’t foster academic progression, Reid said. “What happens is they get out with their associate’s degree, and the thought of going back and taking government and history and other courses is just not appealing. Life gets in the way.”

As a result, Reid, Tart and others are working to revamp that academic model to a “1+2+1” pathway—in which students take one year of general education courses, two years to get their associate’s degree, and a final year to get their BSN—so associate-degree nursing students are more motivated to advance their education. “When students come to us, they’re excited about nursing,” Tart said. “We want them to have the mindset from the beginning, just out of high school, that the bachelor’s, or higher, is their goal.”