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Nursing
Prepared by Louise
Timmer, CSU Sacramento, Lead Faculty for Nursing
Summary of Identified Issues
There was an overwhelming response from the nursing chairs
and faculty from the CSU, UC and community college nursing
programs. Strong interest was expressed in continuing to work
with the IMPAC project. All nursing faculty expressed a need
to collaborate with the ADN and BSN programs to reduce the
barriers for nursing students in the community colleges to
transfer to the CSU and UC nursing programs. Attendees at
the 4 regional meetings included representatives from 16 of
the 17 CSU nursing programs, all UC nursing programs, and
22 of the 71 community college nursing programs. All together
73 nursing faculty attended the four meetings; 12 participants
were chair/director/dean administrators and 61 were faculty.
The meetings were held on Saturday and attendance would have
been higher except for the short timeframe for notification
of the meetings. Several faculty sent regrets but indicated
they wanted to be included in future meetings.
Issues
Several issues, concerns, and needs were discussed by the
chairs and nursing faculty relating to prerequisite coursework,
general education pattern requirements, and transfer and articulation
concerns between the community college and the CSU and UC
systems. Issues were discussed that related to accreditation
requirements with the California Board of Registered Nursing
and the National League for Nursing. The demographic changes
in the nursing student pool and their affect on student enrollment
and composition were discussed. A more detailed description
is provided in the report.
Student Pool
At the San Diego regional meeting, the nursing applicant
pool was discussed. All California nursing programs are experiencing
an older female population in the thirty to forty year range,
second degree students, English as a second language students,
and a more multicultural student applicant pool. Male applicants
continue to be a small number of the applicants. In several
community colleges, English and math competency are significant
issues, as well as interpersonal communication skills. College
coursework remediation and socialization into the nursing
profession are areas of concern. This creates a significant
role for faculty in the preparation of students for professional
practice.
Several faculty remarked that in certain areas of the state,
nursing programs were no longer impacted. However, the health
care facilities in all geographic areas are in need of registered
nurses. Recruitment concerns were discussed and several faculty
recommended that recruitment efforts should include both the
middle and high school students.
Prerequisite Courses
The faculty at every regional meeting expressed a concern
for the science prerequisite, in particular, biology, mathematics,
and chemistry. Some campuses require biology as a prerequisite
to physiology. Mathematics requirements do not contain content
pertinent to nursing practice, e.g., ratios and systems of
measurement. This content is currently being taught in the
nursing programs as a review course or as part of the Skills
Laboratory.
Chemistry was the science course that concerned the majority
of the faculty in both the community college and CSU nursing
programs. Several faculty felt that the chemistry course that
should be a prerequisite to the nursing programs is biochemistry.
However, on community college and CSU campuses, inorganic
and organic chemistry courses are usually required before
students take biochemistry. Several faculty remarked that
associate degree nurses often do not want to take the chemistry
courses required by the BSN programs and list this as a significant
barrier that prevents ADN nurses from seeking the baccalaureate
degree in nursing.
In the interdisciplinary discussions with the chemistry faculty,
the nursing faculty requested a chemistry course be developed
for nursing students that contain a moderate amount inorganic
and organic content, but focused mainly on biochemistry. The
chemistry faculty voiced concerns that included ensuring adequate
enrollment in this course, academic rigor, and appropriateness
in higher education. Discussion focused on academic preparation
for a professional degree such as business, engineering, or
nursing. A chemistry course tailored for the nursing program
at San Francisco City College has been taught and has proven
to be very successful. Chemistry faculty at all regional meetings
were open to further discussion with nursing faculty. Nursing
faculty were asked to determine the competencies for such
a course and if enrollment could be guaranteed, chemistry
faculty would collaborate to develop an integrated chemistry
course for nurses and other allied health students.
Grids
At each regional meeting the grid for the 13 CSU generic
nursing programs was reviewed. All 13 nursing programs require
chemistry, anatomy, and microbiology as prerequisite courses.
However, the social and behavioral sciences, English, mathematics,
nutrition, and speech may either be prerequisites or co-requisites
for admission to the nursing program. Only one nursing program
has physiology as a co-requisite course. The CSU nursing programs
have been meeting all year as part of the CSU Core Alignment
Discipline Project with a grant from the Chancellor's Office.
The goals of this project are to align all prerequisite and
lower division courses among the CSU campuses. The purpose
is to facilitate articulation and transfer within the CSU
system. The CSU nursing discipline project committee anticipates
the total alignment of prerequisites by the end of the academic
year, 2001.
A similar grid for the 71 community college nursing programs
was developed, and is being completed, as a result of the
IMPAC project. This grid was discussed at the final meeting
for the academic year.
General Education Requirements
Faculty from the ADN nursing programs expressed concerns
about the variance in the number of general education (GE)
courses required by the campuses within the community college
system. It was reported that the number of general education
requirements has increased over the past years. Math requirements
have increased on many campuses and additional courses have
been added, such as computer literacy/informatics and critical
thinking. English and history units have increased from 3
to 4 units on some campuses. The GE courses vary between 16-49
units. Faculty believe that the different GE requirements
for each campus create a major barrier for nursing students
to transfer from one campus to another. In addition, the CSU
system has added requirements of English, speech, mathematics
and critical thinking courses that must be taken prior to
transferring from the community colleges. These prerequisite
courses will be especially burdensome for the associate degree
nurse who wishes to transfer to the CSU for the baccalaureate
degree in nursing. At present, only 70 units may be transferred
to the CSU system. Transfer students frequently have many
additional units that are not counted.
Similar barriers exist within the CSU campuses for general
education requirements, creating a barrier for nursing students
to transfer to other CSU nursing programs.
High School Preparation
The faculty discussed the lack of high school preparation
for the study of nursing in college. The students may decide
on the nursing major without having any high school science
and math background. Those students must then take high school
equivalent courses of math and chemistry at the community
college prior to enrolling in the college level courses.
Lower Division Nursing Courses
A grid was reviewed of the 13 generic CSU nursing programs
lower division nursing courses. Very few nursing courses are
offered as lower division, except at CSU Los Angeles. Recently,
CSU Los Angeles aligned their nursing program with some community
colleges in their region. In the pilot program between CSU
Sacramento and Sacramento City College all pre-licensure nursing
courses are lower division to facilitate the transfer of the
community college ADN nurses into the junior year of their
baccalaureate nursing program. However, the CSU nursing students
cannot easily transfer within the nursing programs. It is
anticipated that the CSU Core Alignment Nursing Committee
will review the lower division nursing courses in the next
academic year, 2001-2002.
Matriculation vs. Articulation
The community college nursing faculty expressed the concern
that pre-licensure nursing courses have to be challenged by
examination or retaken to matriculate in some baccalaureate
nursing programs. This policy in not only a barrier to ADN
nurses returning for advanced degrees, but is also very costly
and delays the time to the baccalaureate degree. Out of state
associate degree nurses have similar difficulties when matriculating
into the CSU or UC systems for the baccalaureate degree. If
all pre-licensure nursing courses were lower division in all
nursing programs, articulation could be almost seamless.
A grid for the community college nursing courses is being
developed through the IMPAC Project and will be reviewed at
the April meeting. A barrier to students who transfer within
the community college nursing programs is the difference in
the sequencing of nursing courses in the program.
At the Bakersfield meeting, the Interim Director of Nursing
at the College of the Redwoods, Meredith Trinque, shared her
experience in the development of a fully articulated LVN to
RN to BSN nursing model for the state of Connecticut. She
mentioned that three states, Colorado, Maryland, and Connecticut
have developed state articulated nursing programs that follow
a career ladder beginning with the licensed vocational nurse
(LVN) to the associate degree nurse (ADN) to the baccalaureate
degree nurse.
Accrediting Agencies Requirements:
National League for Nursing Accrediting Commission (NLNAC)
and California Board of Registered Nursing (BRN):
ADN faculty expressed a concern in content requirements and
unit limitations identified by accrediting agencies; National
League for Nursing Accrediting Commission (NLNAC) and the
California Board of Registered Nursing (BRN). Currently, the
NLNAC maintains a standard of 60-72 semester units/credits
(90-108 quarter) for Associate degree Nursing programs. The
BRN identifies content as follows: 36 units for the arts and
science for nursing, six units for communication and 16 units
for related natural, behavioral and social sciences. The 22
units (6 units for communication and 16 units for natural,
behavioral and social sciences) may count for the general
education requirements for the associate degree. However,
on some community college campuses there may be additional
general education course requirements for the associate degree.
In colleges where this is the case, a student's progress toward
an associate degree may be slowed.
Furthermore, the NLNAC limit of 72 semester units may be
surpassed and accreditation for the nursing program may be
placed in jeopardy. As the complexity and acuity of patients
in the health care facilities increased over the years, the
need arose for more knowledge and clinical training to achieve
competency in the nursing content areas required by state
law. This has resulted in a curricular dilemma among faculty
attempting to keep to a specified timeframe and the unit standard
for the pre-licensure nursing programs. Some faculty expressed
a desire to dialogue with other faculty and consultants from
the BRN as to what content and clinical experiences to keep
and what to eliminate from the nursing curricula and still
have students achieve competency in the content areas required
by California law.
1998 PEW Commission Report on the Health
Professions
The 1998 PEW report on Health Professions may need to be
reviewed as it indicates several competencies for the entry
level nurse that increase the theory and clinical units needed
to meet them. There appears to be a philosophical conflict
between the 1998 PEW Report and NLN expectations of entry
level nursing programs.
Identified Trends/Future Directions
Enrollment Capacity
Enrollment is limited in all of the 94 pre-licensure and
26 master's degree nursing programs, both state-supported
and private. The latest statistics on enrollment in California
nursing programs was compiled 1998-991. At this time, there
were 3556 ADN, 1447 BSN, and 35 entry level master nurses
graduated, totaling 5038 new graduates from all 94 pre-licensure
nursing program. Unfortunately, over the past 5 years, applications
to pre-licensure nursing programs have declined throughout
the state. California Employment Development Department (EDD)
concluded that the state does not have a sufficient supply
of nurses to meet the health care demand in the next 10 years.
By 2006, EDD projects an increase need of 67,440 new registered
nurses over the 197, 000 nurses currently employed. According
to the California Department of Consumer Affairs, California
ranks the 50th in the nation in the proportion of RNs to 100,000
population (585/100,000).
From the figures presented by the Consumer Affairs Department,
California has two problems; limited capacity in pre-licensure
nursing programs and a declining interest in pursuing nursing
as a career.
Increase Demands for Nursing Services
The changes in the health care system to managed care and
integrated health care networks have increased the demand
for RNs prepared at the baccalaureate and master levels. The
need for nurses with advanced practice in primary care is
increasing in the integrated health care systems. Nurses are
expected to delivery primary health care in clinics and community
health settings and provide supervision and training for other
health care personnel.
Registered nurses are expected to manage many patients in
a hospital or community health agency and supervise care given
by other licensed nurses and unlicensed health care workers.
Health education and home health care are increasing the responsibilities
of registered nurses. Public health caseload continues to
rise as the numbers of uninsured persons, homeless, and indigent
citizens increase.
Changes Needed in Nursing Education:
For the past five years, several nursing organizations have
met with nursing faculty in the state supported and private
universities and colleges to explore and develop better systems
of education and articulation in order to meet the critical
nursing shortage in California. In 1999, the California Strategic
Planning Committee for Nursing (CSPCN) developed a model for
role differentiation in nursing practice. The model addressed
the educational preparation, competencies, and skills among
the registered nurses. CSPCN includes representatives of over
40 nursing organizations in California and its purpose is
to establish a master plan for the nursing workforce that
will ensure an adequate supply of nurses for the state. The
goal is to create a mechanism whereby nurses may progress
through an education process that progresses from LVN to ADN
to BSN to MSN. The intent is to align curricula in the licensed
vocational nursing (LVN) and RN nursing programs so to
reflect education and competencies for each level of education.
All competencies are based on California law as administered
by the California Board of Vocational Nursing and the California
Board of Registered Nursing.
Unlike previous nursing shortages, health care employers
not only predict an increased need for registered nurses but
also a need for bachelor and master prepared nurses. Approximately,
73% of nursing admissions are to associate degree programs
and while these admissions are expected to increase, admissions
to BSN programs are decreasing each year. At present, only
16% of associate degree RNs continue their nursing education
and obtain higher degrees. Changes in nursing education must
occur to ensure that California has a nursing work force with
the appropriate education and skills to meet the state's health
care demands. The Institute of Medicine study in 1994 concluded
that the educational mix of nurses is inadequate for current
and future delivery of nursing services. The education of
nurses needs to be aligned with the levels of professional
judgment required of nurses in all health care settings. Nurses
must be able to work in complex health care systems that demand
a high level of clinical judgment, management skills, and
increasing clinical autonomy to supervise other health personnel.
Comments from Statewide Meetings and
the General Field
The nursing faculty made several comments. These comments
included:
Most useful part of the discussion
- Sharing with faculty from other nursing programs
- Sharing of common issues, number of units, common issues
in related disciplines
- Collaborating with nursing colleagues
- Understanding what each nursing program requires.
- Cross disciplinary discussions, CAN discussions, discussions
with biology, chemistry, math faculty
- Prioritizing of issues for nursing programs. Ideas for
more successful sessions included:
- Break up sessions for community college and CSU nursing
programs and have one representative present the ideas during
the whole nursing session.
- Identify how nursing programs can clean out the deadwood
courses that all community colleges agree to and add common
core courses. Then discuss the same with the CSU and UC
nursing programs.
- Have national league for nursing and board of registered
nursing representatives at the meetings.
- More direction in preparing for meetings with other disciplines.
- Invite hospital administrators to meetings
The information was shared with other faculty at department
meetings. All faculty wanted to continue to meet together
to work on common issues among the nursing programs in the
CSU,community college, and UC systems. The faculty identified
activities to become involved in at the local level for articulation
such as:
- Work with campus chemistry or community college chemistry
faculty to design an integrated chemistry course.
- Discussion with campus biology, chemistry, math, and
computer science faculty to align nursing competencies with
science prerequisite courses.
- Update local articulation agreements with community colleges
for nursing programs.
When asked how the nursing faculty heard about the IMPAC
meetings, responses included:
- Letter from IMPAC and nursing dept. chair
- IMPAC's nursing discipline coordinator, Louise Timmer
- Nursing director of college
Recommendations for the Discipline
1. Develop an articulated set of prerequisite and lower division
nursing courses for the ADN and BSN programs and reduce matriculation
barriers between ADN and BSN programs. Specifically,
- Create grids with course descriptions for the prerequisite
courses and lower division courses in the ADN and BSN programs,
both private and public, in California.
- Create grid for community college ADN programs that describes
the number and composition of units to the degree.
- Discuss which courses would serve as California Articulated
Number (CAN) courses.
- Survey BSN programs, public and private, to determine
matriculation barriers to admission for the ADN transfer
students.
2. Review preparation of students for admission to nursing
programs. Specifically,
- Create grid of admission requirements for ADN and BSN
programs, public and private.
- Review grid to determine similarities and differences.
- Review retention and attrition rates for ADN and BSN programs.
- Review remediation process for ADN and BSN programs.
- Review passage rate for state board licensure exam for
nursing programs.
- Determine relationship among preparation level for admission,
retention rates, remediation process and success, attrition
rates and passage rates for the state board licensure exam.
- Discuss feasibility of pre-entrance assessment testing
for admission to nursing programs.
3. Meet with the Board of Registered Nursing Education Consultants
and representatives from the National League for Nursing Accreditation
Consultants to discuss content areas and units to the degree
for ADN programs. Specifically,
- Arrange meetings for ADN programs/faculty who want to
meet with the BRN education consultants to discuss content
areas, competencies, skill sets and units required for licensure
in California.
- Arrange meetings for ADN programs/faculty who want to
meet with the NLN Accreditation consultants to discuss the
maximum number of units to the degree acceptable for accreditation.
4. Develop nursing recruitment strategies for the students
in the K-12 grades.
- Discuss recruitment ideas that provide K-12 students with
opportunities to observe the diversity of nursing care given
by registered nurses in all health care settings.
- Develop campus-school programs that link K-12 students
to activities with nursing students.
- Develop recruitment programs that reach all segments of
the community.
- Seek funding sources; public and private, grants and community
partnerships, to implement the recruitment strategies.
Recommendations for Support Courses
(if discussed)
1. Create an integrated chemistry course for all nursing
programs. Specifically,
- Determine content, competencies, and skills set for an
integrated chemistry course.
- Hold campus meetings with the chemistry departments to
discuss the components of an integrated chemistry course.
- Determine feasibility of the integrated chemistry course
as a CAN course.
2. Review the General Education Patterns on the college/university
campuses with ADN and BSN programs. Specifically,
- Determine the competencies, skills set, and units required
for general education patterns at each campus.
- Create grid for the general education patterns on campuses
with ADN and BSN programs, public and private. ·
Review grid for similarities and differences.
- Determine whether general education courses are/can be
CAN course.
- Discuss feasibility of dual enrollment in the community
college and CSU system for the prerequisite and general
education courses.
Topics for Further Discussion
All of the recommendations listed above are unresolved issues
that need further discussion and decisions made to facilitate
student articulation and transfer process among and between
the community college, UC, and CSU systems. In addition, further
discussion of the recruitment and retention issues in the
nursing programs need further elaboration to discover what
factors impact on recruitment and retention of students in
the nursing programs in the community college and CSU systems.
CAN numbers for common prerequisite and lower division nursing
courses are essential topics for next year. Discussions of
essential content, competencies, skills with the accrediting
organizations for the nursing programs of the community colleges
will be made available. Lastly, a discussion relating to a
statewide articulated nursing curricula beginning with the
LVN and progressing to the BSN such as the Connecticut model
will occur at next year's meetings.
Recommendations Forwarded/to be forwarded
to:
CAN: The prerequisite courses
and nursing courses for the pre-licensure nursing degree will
be discussed and decided next year, 2001-2001.
ASSIST: The prerequisite courses
and the nursing courses will be reviewed next year.
CIAC: Meetings with the counselors
for the community college and CSU nursing programs will be
held next year.
Outreach presentations made by members
of this group:
California Hospital March 8, 2001 Louise Timmer
Association American Nurses Association of California March
10, 2001 Louise Timmer
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