In 2012, the American Organization of Nurse Executives (AONE), representing the Tri-Council of Nursing: AONE, the American Association of Colleges of Nursing (AACN), the American Nurses Association, and the National League for Nursing, was selected by the Robert Wood Johnson Foundation as the national program office for the Academic Progression in Nursing (APIN) initiative. This initiative was created to support the 2010 Institute of Medicine (IOM) recommendation that appeared in its groundbreaking report, The Future of Nursing: Leading Change, Advancing Health,1 to increase the proportion of nurses with a BSN or higher degree to 80% of the nursing workforce by 2020.
The original APIN 2-year initiative funded 9 state action coalitions with up to $300 000 over 2 years to implement state action plans to achieve the IOM's 80% BSN or higher educated workforce goal.1 Participating states-California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington-have spent more than 2 years implementing and evaluating 1 or more of the following practices to increase the number of nurses with a BSN or higher degree: (1) competency-based curricula, (2) a shared statewide or regional curriculum, (3) RN-to-MSN programs with a BSN exit potential, and (4) community colleges conferring BSN degrees.
APIN Impact
After 21/2 years, the APIN initiative is producing results as all the states have made significant progress with their action plans, and the national numbers reflect the work in the 9 APIN states as well as the work being undertaken across the country to meet the 80/20 goal. Data from AACN2 show a 69% increase in enrollments in RN-to-BSN completion programs (Figure 1). Highlights of the outcomes achieved in each APIN state over this period are as follows:
* California: Development of a dual enrollment collaborative that includes California State University, Los Angeles (CSULA), and 12 community colleges. This work resulted in alignment of prerequisites, standardization of academic unit credit for successful passage of the NCLEX-RN, and a memorandum of understanding that defines the roles and responsibilities of the community colleges and CSULA; the model is self-supporting.
* Hawaii: Development of a dual enrollment model-for both BSN and associates degree in nursing (ADN) students-based on the baccalaureate essentials in nursing3 has resulted in strong collaboration between academic and practice partners and state programs.
* Massachusetts: From 2010 to 2013, there was an increase of 34% in BSN graduates and an 81% increase in the number who received their BSN postlicensure. The Nursing Education Transfer Compact, which allows credits to transfer from an ADN program to a BSN program, is being implemented with the strong support and leadership at the state level.
* Montana: The engagement of practice partners and the state higher education commissioner in the APIN leadership council and the work being undertaken in the state to advance nursing education was leveraged to receive a multimillion dollar Department of Labor grant with an academic progression component.
* New Mexico: Through the strong community college and university partnerships established through the New Mexico Nursing Education Compact, BSN education is now offered in 6 locations with 4 of these on community college campuses. By 2018, the BSN will be offered in 20 locations.
* New York: For the 1st time in 40 years, 2013 and 2014 data showed that there were more BSN graduates than ADN graduates, and the projection for 2015 is favorable. The dual admission 1 + 2 + 1 program has expanded across the state with public and private institutions partnering to provide seamless academic progression.
* North Carolina: The state has scaled up its regionally increasing baccalaureate nurses (RIBN) dual enrollment program to include 332 students in 2014 representing 9 regional universities and 31 community colleges. The RIBN dual enrollment program has prompted other institutions to be creative in developing additional seamless academic progression models. In addition, a uniform RN-to-BSN articulation agreement has been approved, which will enhance seamless academic progression from ADN-to-BSN programs statewide.
* Texas: The Consortium to Advance Baccalaureate Nursing Education in Texas model is a statewide articulation model that increases transparency and decreases duplication for ADNs who are progressing to an RN-to-BSN program. This work has resulted in an increase in the percentage of RNs with a BSN or higher to 54% and increased the percentage of ADN graduates moving on to BSN from 15.7% to 21%.
* Washington: The number of nurses enrolled in RN-to-BSN programs was increased by 15%; a direct transfer agreement was developed with 14 early adopter programs in the process of implementing the agreement. The APIN work has increased the collaboration and cooperation between educators and regulators. These partnerships are being leveraged now with their practice partners to ensure the sustainability of this work.
In addition to these individual state academic progression outcomes, the APIN national program office, in collaboration with the Center to Champion Nursing in America, brought together a small group representative of community college and university nursing programs, employers, regulators, and APIN and statewide implementation program representatives to address the following objectives related to academic progression:
* Analyze the prerequisite and general education requirements in promising academic progression programs.
* Propose an ideal set of prerequisite and general education requirements for RN-to-BSN programs for broader national consideration.
After lengthy discussion and the assumption that the requirements for a BSN should be the same or very similar regardless of what pathway is taken to achieve the BSN, the group identified an ideal set of foundational courses for the current BSN (Figure 2). It is hoped that this work will be shared broadly so that community colleges and universities can adopt or adapt these foundational courses within their programs, which would establish the consistency in prerequisite and general education requirements that appears to be lacking in RN-to-BSN academic progression models. With consistent application of these requirements, seamless academic progression can become a reality.
The Work Continues
At the conclusion of the 2-year grants in August 2014, all 9 states were awarded 2-year continuation grants to further the progress they made with their original grant proposals. The APIN-2 grants will focus on scaling up the selected models to further increase the number of BSN or higher prepared nurses. The grants also will focus on implementation of a comprehensive diversity and inclusion plan to help create a nursing workforce in the state reflective of the communities they serve. Lastly, the grants will focus on academic-practice partnerships in the cocreation of new models of nursing education to meet the needs of the current and future nursing workforce and a sustainability plan that will foster continued operational and financial support of the educational model beyond the grant period, including a component that explains how program operations will be institutionalized within partner organizations.
Although there is still much work to be done across the nation to increase the percentage of BSN or higher-educated nurses in the workforce, the 9 APIN states continue to make strides in fostering seamless academic progression. For more information, visit the Campaign for Action APIN Web site at http://www.campaignforaction.org/apin.
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