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A multi-pronged strategy is under way to transform nursing education in Washington state and add thousands of new RNs trained to meet the healthcare needs of a large and aging baby boomer population.

Immediate priorities are to increase the supply and competencies of RNs, expand nursing faculty, promote diversity in the profession, and enhance access to nursing education in rural and underserved areas.

"We want to attract and retain the best nurses and best nursing faculty by addressing these key interlocking issues," says Linda Tieman RN, MN, FACHE, executive director of the Washington Center for Nursing.

As a framework to meet nursing goals, the center has developed a comprehensive Master Plan for Nursing Education with input from a wide spectrum of the healthcare industry. Tieman says 14 focus groups were held over a two-month period last year with nearly 200 nurse administrators, educators, staffers, and nursing students.

Averting RN shortages

The plan was presented in late March to the Washington Department of Health, which funded the project. While awaiting feedback from state officials, the center is preparing to implement multiple strategies to enhance and expand the RN workforce.

Tieman says there is no time to waste in light of a center study showing the state faces a severe shortage of nurses that could reach 25,000 RNs by the year 2020 without changes in education and practice policies. That means 400 new nurses would have to be added annually for the next 15 years just to keep up with demand, she says.

With 31.6% of the state's nurses age 55 or older, most will reach retirement age about the time they'll be most needed to handle peaking demands for patient care, Tieman says.

The master plan presents 93 recommendations for avoiding an RN shortage crisis, including a blending of ideas for creating a seamless, innovative, and affordable nursing educational system that encourages advanced degrees and lifelong learning.

Targeting priorities

The master plan pinpoints three immediate priorities that are considered achievable —

• Finding capacity for 750 more students, the number of qualified applicants turned away last year by state nursing schools

• Adding 150 new full-time faculty members statewide

• Increasing faculty salaries to a competitive level

Ann Hirsch, RN, PhD, associate dean of nursing at Washington State University, says pre-licensure nursing schools have done a fabulous initial job, increasing student capacity by 80% since 2001.

"There's been a huge expansion, but schools are still accepting only half the qualified applicants, so there's more work to do," Hirsch says.

Also, most nursing education is clustered in the western part of the state in urban centers, leaving a huge rural region where opportunities to enter nursing can be increased with distance learning programs, Hirsch says.

Developing faculty

Greater emphasis must be put on supporting teaching careers and recruiting educators from diverse cultural backgrounds to relieve a serious shortage of nursing school faculty, Hirsch says.

More loans and scholarships for students to get their master's degrees and PhDs can be put in place quickly, along with incentives for going into teaching such as tuition forgiveness, she says. "We need new PhD grads who are 27 or 28 so they have a long academic career."

Although salaries are a major factor — faculty members typically earn 25% to 50% less than they would in a clinical setting — the state could offer them 12-month instead of nine-month appointments, which would increase pay, Hirsch says. Faculty also could be given more time and seed money for research.

"Most tenure-track faculty are scholars, and they need time to work on research and publishing," Hirsch says. "Career satisfaction is important."

The workload of advanced-degree faculty also could be reduced with part-time assistants, more clinical instructors, and a policy letting students take some required but non-nursing courses from instructors in other college departments.

Highly qualified instructors also could be given assistance to obtain PhDs if they would remain in faculty roles.

Reaching out

Lower Columbia College in Longview is preparing to help bridge the gap in rural education in 2009 by providing students online access to seven full quarters of nursing curriculum. The college is partnering with hospitals, nursing homes, and clinics to identify staff workers who would be good candidates for the virtual two-year nursing degree program.

The Rural Outreach Nursing Education project is supported by grants and would let a student qualify in the work environment as a certified nurse assistant, progress to an LPN, and go on to acquire an RN degree.

Clinical and simulation experience will be made available in, or close to, the rural communities where these students work and reside, says Helen Kuebel, RN, MSN, director of nursing at the college and a contributor to the master plan.

Kuebel says a consortium of healthcare providers on either side of the Cascades are supporting the virtual campus option, scheduled to get under way with its first cohort of 20 students in January 2009.

Lower Columbia in late 2007 also launched an accredited online LPN-to-RN program that provides all required theory courses needed for an associate's nursing degree. The technology is designed to help the advancement of working LPNs whose schedules or locations prevent them from attending campus-based programs.

Chasing solutions

An implementation manager is being hired to identify resources needed for solving each of the master plan's priority areas, Tieman says.

The breakdown will help obtain donations, grants, and state funding for specific projects.

"We'll look at the contingencies and dependencies, and determine what's already in place," Tieman says. "We're looking for the real deal-breakers — what we absolutely need to move forward."

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John Leighty is a freelance writer. To comment, e-mail editorNW@nurseweek.com

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