Charting Nursing’s !"#"$%
Reports on Policies That
Can Transform Patient Care
A Publication of the Robert Wood Johnson Foundation
Implementing the IOM Future of Nursing Report—Part I:
How to Dramatically Increase the Formal Education of
America’s Nursing Workforce by 2020
In October 2010, the Robert Wood Johnson at how key players are responding. The report calls
Foundation (RWJF) and the Institute of Medicine for increasing the percentage of nurses holding the
(IOM) jointly released The Future of Nursing: Leading bachelor of science in nursing (BSN) degree or higher
Change, Advancing Health, calling it a blueprint for to 80 and for doubling doctorates by 2020. This will
transforming the American health system by strength- require fundamental changes: new competency-
ening nursing care and better preparing nurses to based curricula; seamless educational progression;
help lead reform. This issue begins a four-part mini- more funding for accelerated programs, educa-
series on the report, digesting its educational pro- tional capacity building, and student diversity; and
gression recommendations and offering an early look stronger employer incentives to spur progression.
Issue Number 16
Figure 1 Highest Academic Nursing Degree Held by Working Nurses Page
A Call to Concerted Action 2
Diploma 13.3% IOM Recommendations at a Glance 2
Associate 38.7% How to Achieve “80 by ’20” 3
Create Seamless Pathways 3
Enhance Employer Incentives 4
Master’s 10% Fund BSN Capacity Expansion 4
Proﬁles in Leadership 4
A Model Employer Incentive Program 5
Percent Distribution 0% 25% 50%
Up Accelerated Program Funding 5
To achieve both IOM educational progression metrics, at least 760,000 additional nurses must Enhance Diversity 6
earn at least a BSN (or BS). An additional 24,147 must earn a doctorate by 2020, according to the
American Association of Colleges of Nursing. Degrees earned by both new nurses and working How to Double Doctorates by 2020 7
nurses returning to school count toward the metrics. Increase Graduate Admissions 7
Source: Adapted from data provided by the Health Resources and Services Administration (HRSA) from its 2008
National Sample Survey of Registered Nurses. The display reﬂects RNs working as nurses, not all RN license holders, Up Accelerated Program Funding 7
many of whom are retired or working in other ﬁelds. Improve Faculty Compensation 8
The Value of Accelerated Programs
The nursing student pictured on the right checking the heart sounds
of a young patient is enrolled with scholarship support in New Careers
in Nursing, an accelerated second-degree BSN and master’s of sci-
Photo: Texas Tech University Health Science Center
ence in nursing (MSN) program funded by RWJF and administered by
the American Association of Colleges of Nursing (AACN). For more,
see “New Careers,” page 5.
Second-degree accelerated programs are a gift to nursing, say
experts, because they are attracting students with mature profes-
sional goals and rich backgrounds from other disciplines as well as
sharply reducing time spent in school. They are also enrolling more
men than many conventional nursing programs and thus are helping
to overcome the signiﬁcant underrepresentation of men in nursing.
The IOM report calls on public and private funders to increase fund-
ing for expedited degree programs to help raise current workforce
educational levels (see Figure 1) signiﬁcantly by 2020.
A Call to Concerted Action
The Future of Nursing: Leading Change, Advancing Health sion, using all the tools we have, and we must reach out to
(October 2010), is animated by the most positive of visions: partners in other sectors to help us achieve this goal.”
health care for all Americans that is patient centered, high This inclusiveness is echoed by others close to the re-
quality, seamless, and affordable. port’s development. They imagine success on progression
The vision also anticipates the enormous challenges as driven by diverse and mutually respectful partners and
ahead for health care: expanding demand for care, older are conﬁdent that patients, nurses, and aspiring nurses in
and sicker patients, more complex technology, new health all demographic groups will beneﬁt.
care settings and team conﬁgurations—all emerging as the “Educational progression does not disenfranchise any-
country struggles to address serious nurse and nurse fac- one,” says IOM Future of Nursing committee vice chair
ulty shortages and implement the Affordable Care Act. Linda Burnes Bolton, DrPh, RN, FAAN, vice president and
At the center of the vision is a nursing workforce that chief nursing ofﬁcer, Cedars-Sinai Medical Center. “It’s
will be better educated and more ready to take on new about inclusivity. All nurses must continue to learn.”
roles as care providers and leaders in health reform. Decades of work by major nursing associations inform
To make this vision a reality, the report and its diverse the report’s educational progression aims, which are
and prestigious leadership call on all nurses, as well as framed by a theme—achieving higher levels of education
other health care stakeholders, to set aside divisive through improved and seamless academic pathways—and
debates and begin a decade of concerted action to by two ambitious goals: increasing the percentage of
increase the formal education of America’s nurses. nurses with the BSN or higher to 80 percent and doubling
“We must all stand together as a profession to make the number of nurses with doctorates by 2020. Nine imple-
health care better, not quibble about whether the ADN or menting recommendations and related key players deﬁne
the BSN degree is better. Both have value,” says Susan B. the road to success (see “IOM Recommendations,” below).
Hassmiller, RN, PhD, FAAN, who led the study that preced- The following pages offer a range of strategies for
ed the report and who now heads up The Future of Nursing: achieving the recommendations, drawn from the report and
Campaign for Action, an emerging group of state Action from interviews with key players.
Coalitions and other key stakeholders working to imple- Issues 17 through 19 of the Charting Nursing’s Future
ment the report’s recommendations. “To address future (CNF) series will explore the report’s interdisciplinary col-
health care needs, we must accelerate educational progres- laboration, primary care, and scope of practice themes.
“We must all stand together as a profession to make health care better—not
quibble about whether the ADN or the BSN degree is better. Both have
value. To address future health care needs, we must accelerate educational
progression, using all the tools we have, and we must reach out to partners
in other sectors to help us achieve this goal.”
Susan B. Hassmiller, RN, PhD, FAAN, senior advisor for nursing, RWJF,
and director, The Future of Nursing: Campaign for Action
For More Information
!"#$%&'()*+$,&'(-,).+%+$/ will switch to electronic distribution in
• Visit www.nap.edu (click “Health and Medicine”) for an IOM report.
2011, beginning with issue 17 (the next issue). To continue to re-
• Visit www.thefutureofnursing.org/IOM-Report for more on The
ceive the series after the switch, register at www.rwjf.org/goto/cnf. Future of Nursing: Campaign for Action.
student diversity. Private and public
IOM Educational Progression Recommendations at a Glance
funders (see pp. 4–6).
Needed Actions and Key Players: • Increase funding for students pursu-
• Require seamless academic pathways ing second-degree programs. Federal
Nurses should achieve higher levels
beyond articulation agreements. agencies such as the U.S. Secretary of
of education and training through
Accreditors: Commission on Collegiate Education and HRSA (see pp. 1 and 5).
an improved education system
Nursing Education (CCNE) and the • Design and implement curricula pro-
that promotes seamless academic
National League for Nursing Accrediting moting interprofessional collaboration.
Commission (NLNAC; see pp. 3–4).† Health professional schools (see CNF 17,
• Enhance employer incentives to drive forthcoming in the fall of 2011).
Undergraduate Education Metric: BSN attainment within ﬁve years of • Enhance the diversity of nursing
Increase the percentage of nurses graduation. Health care organizations students. Nursing education leaders,
holding the BSN degree or higher to (see pp. 4–5). health care organizations, and schools
80 percent by 2020.* • Expand BSN educational capacity and (see p. 6).
How to Achieve “80 by ’20”
Leaders of major nursing organiza- designed to prepare the “new nurse.” Promote RN-to-MSN Programs.
tions and other important players The model coadmits students and “A BSN completion program isn’t the
interviewed for this issue describe the offers portable ﬁnancial aid, shared ﬁnal destination for everyone,” says
IOM recommendations as “validat- institutional resources, and signiﬁcant Kristen Swanson, PhD, RN, FAAN,
ing” and “energizing.” Most are now clinical education innovations. dean and Alumni Distinguished
engaged in strategic planning to help “OCNE is one of the most promis- Professor, University of North Carolina
implement the recommendations. ing models we have for increasing the Chapel Hill (UNC-CH) School of
They regard “80 by ’20” as a com- numbers of students moving quickly Nursing. “Some ADN-prepared nurses
pelling goal but acknowledge its huge from the ADN to the BSN,” says return to school wanting to move
challenges: educating at least 760,000 Brenda Cleary, PhD, RN, FAAN, past into leadership, teaching, advanced
additional nurses to the BSN level or director, the Center to Champion practice, or research roles.” UNC-
higher, achieving fundamental shifts Nursing in America (see “Proﬁles in CH’s RN-to-MSN program prepares
in education and practice, and speak- Leadership,” p. 4, for more on OCNE). students for all these roles.
ing with one voice about the impor- The National League for Nursing Admitted as graduate students,
tance of progression. (NLN) has created the LEAD pro- nurses ﬁrst take three online BSN
Yet there is optimism and a will to gram to train faculty in how to build competency bridge courses and then
experiment. “The report has encour- transformative educational changes move to an on-campus master’s
aged people to think creatively,” says like OCNE. “You need faculty de- degree curriculum with a wide variety
Pamela Thompson, MS, RN, CENP, velopment to deliver competency- of concentrations. Students can
FAAN, CEO, American Organization of based models—skills in motivating complete the program in two years,
Nurse Executives (AONE). “The ﬁeld and working with others,” says although many take longer because of
is developing a variety of strategies to Bev Malone, PhD, RN, FAAN, NLN’s work and family commitments.
get to the BSN goal. Because the re- CEO.“There is a big hole there, and The IOM report, many nurse edu-
port isn’t prescriptive about methods, we want to ﬁll it.” cation leaders, as well as Roxanne
it has a high probability of success.” Emerging Action Coalitions in Fulcher, director, health profes-
Florida and Texas are taking ini- sions policy, American Association of
Create Seamless Pathways tial steps toward seamlessness by Community Colleges (AACC), argue
Replicate the Oregon Consortium for strengthening articulation agree- that RN-to-MSN programs merit
Nursing Education (OCNE).There is ments. The Texas coalition will also much more attention and support.
great interest in spreading versions of standardize BSN prerequisites and Advance Expedited Licensed Vocational
the OCNE model, which includes eight develop coadmission policies. Nurse (LVN) Education. For Texas, a
community colleges and the ﬁve cam- Fully Utilize BSN Completion Programs. state with exceptionally high numbers
puses of the Oregon Health & Science The nation’s 633 RN-to-BSN pro- of LVNs, a model accelerated LVN-to-
University (OHSU). OCNE is the ﬁrst grams have seen a 21 percent enroll- Continued on page 4
For More Information
fully integrated consortium program ment increase recently but still have • The NLN’s annual meeting (Sept. 21-24,
that enables students to progress unused capacity (AACN); stronger 2011) will focus on educational progression.
Visit www.nln.org for more information.
seamlessly from the ADN through employer incentives could spur utili- • Visit aacc.nche.edu/Publications/Briefs/
the BSN with a common curriculum zation by working nurses. Documents/2011-02PBL_DataDrivenNurses.
driven by a single set of competencies pdf (page 10) for more on RN-to-MSN
Graduate Education Metric: • Create market-competitive compen-
Double the number of nurses with sation packages for nursing faculty.
doctorates by 2020. Academic administrators and university
trustees (see p. 8).
Needed Actions and Key Players: *The Future of Nursing: Campaign for Action will measure
• Monitor schools of nursing to ensure the percentage of nurses with both nursing and nonnursing
degrees for both the IOM educational progression metrics.
a 10 percent increase in the number †Staff from the CCNE and others advise that the CCNE can-
of BSN graduates entering graduate not require nursing programs nationally to develop articula-
tion agreements or other academic pathways, but would
programs within ﬁve years. Accreditors: certainly evaluate whether such programs are meeting stated
CCNE and NLNAC (see p. 7).
• Expand funding for accelerated gradu- “What’s important here is that we are educating nurses
ate programs and student diversity.
better for wider responsibilities.”
HRSA, Department of Labor, and other
Donna Shalala, chair, IOM Future of Nursing committee, and president, University of Miami, Coral
funders (see p. 7). Gables, Florida
Profiles in Leadership How Seven OCNE Leaders Created Trust and a New Reality “80 by ’20” continued
!"#$%&'()*+$,&'(-,).+%+$/ salutes seven nurse leaders who helped make OCNE possible:
Marna Flaherty-Robb, MSN, CNS, RN, chief nursing informatics ofﬁcer, University of Michigan
School of Nursing
Paula Gubrud-Howe, EdD, MS, FAAN, OHSU associate dean for academic partnerships, technology, RN program has made good sense and
and simulation, and OCNE codirector has, in fact, inspired 40 percent of
Kathleen Potempa, PhD, RN, FAAN, president, AACN, and dean, University of Michigan School of Nursing
Mary Schoessler, EdD, RN-BC, co-investigator of OCNE’s FIPSE evaluation grant and professional
recent graduates to pursue the BSN.
development specialist, Providence Portland Medical Center Initially funded as a pilot by the Texas
Louise Shores, RN, EdD (retired), former educational consultant, Oregon State Board of Nursing, Higher Education Coordinating Board,
and ﬁrst director of OCNE
the program is now a partnership be-
Chris Tanner, RN, PhD, FAAN, Youmans Spaulding Distinguished Professor, OHSU School of Nursing
Linda Wagner, MN, RN, nursing department chair, Rogue Community College, and OCNE codirector tween Angelo State University and 15
hospitals, many in rural areas.
In 2000, when prospective OCNE leaders met to confront the state’s looming nurs- Hospitals handpick LVNs for par-
ing shortage, as part of the Oregon Nursing Leadership Council, about the only ticipation, pay their tuition, allow re-
thing they could agree on was how bad things would be if they couldn’t produce
lease time, and serve as clinical sites.
The university uses NLN competencies
Yet a decade later, they and their successors have created a model that has
to offer credit to those who test out of
more than doubled the state’s previous rate of ADN-to-BSN progression, impressed
employers, and provided inspiration for adaptations in Hawaii, California, Wyoming, required specialty courses, and then
New York, and North Carolina (New Mexico and others are planning versions of supports them as they complete a 21-
OCNE). Eight leadership lessons from the OCNE development experience follow. week intensive curriculum with clinical
and online didactic components. Na-
1. Have a Forward-Looking Vision: ous external efforts to destroy it.
tional Council Licensure Examination
The group’s vision of the “new nurse” Gubrud-Howe and Wagner, for ex-
pass rates are now at 95 percent.
united and sustained it. “We stopped ample, who were both directing nurs-
quibbling about degrees and focused ing programs in community colleges
on competencies needed for the fu- as OCNE began, ran interference with Enhance Employer Incentives
ture,” says Tanner, a faculty develop- college presidents and promoted the “We must make returning to school a
ment guru with a knack for bringing consortium’s value tirelessly. probability for working nurses with
people together. Flaherty-Robb ADNs,” says Liana Orsolini-Hain, RN,
5. Embrace Difference: “Part of PhD, nursing instructor, City College
researched the state’s future health
OCNE’s energy is bringing multiple of San Francisco, member, IOM
care needs and did key work on the
perspectives to the table and creat- committee, and RWJF Health Policy
ing something new out of that,” says
Fellow. Without more widespread
2. Build Trust Early: Potempa, who Schoessler, who has made major con-
employer educational requirements
took on OCNE’s early leadership as tributions to consortium evaluation
and supports, “80 by ’20” cannot be
OHSU’s dean of nursing, hired Robert and its clinical education component.
achieved. Since 83.3 percent of new
McCarthy, a nonnurse with creden-
6. Involve the Community: “We had nurses work in hospitals, the willing-
tials in labor negotiation and orga-
school presidents take the mes- ness of chief nursing ofﬁcers to take
nizational development, to facilitate
sage of OCNE to the people,” says a stand on progression will be pivotal
the resolution of old conﬂicts and get
Potempa. “Then they heard directly (see “A Model Employer,” p. 5).
people talking about the hot-button
from constituents about the need for The Magnet Recognition Program
issues. “You must build trust before
educational progression.” has been a national leader in promot-
doing anything strategic,” he says.
7. Don’t Let Fear Block Creativity: ing educational progression. A task
3. Share Leadership: Leadership was force appointed by the program is
Shores, recognized as a gifted con-
a matter of expertise and lever-
sensus builder highly inﬂuential with now considering whether to embed
age, not ego, within the OCNE circle.
the Oregon State Board of Nursing, the “80 by ’20” metric in Magnet
Individuals took charge or followed
kept the group from repressing its accreditation standards, says Karen
as the situation dictated.
creativity. “I continued to reinforce Drenkard, PhD, RN, NEA-BC, FAAN,
4. Hang Tough and Repeat the Truth: this message: ‘The board is not op- executive director, American Nurses
The consortium prevailed over seri- posed to improvements in nursing.’” Credentialing Center. A decision to do
so would raise the current progression
8. Reach Out to Other Sectors: “We have removed bar in 400 hospitals nationwide.
every imaginable educational barrier to academ-
ic progression. Now others must help remove Fund BSN Capacity Expansion
Grow University BSN Programs. A
the ﬁnancial and workplace barriers that hold dramatic increase in baccalaureate
students back.” enrollment is needed, yet lack of
Chris Tanner, RN, PhD, FAAN, Youmans Spaulding Distinguished faculty, clinical placements, and other
Professor, OHSU School of Nursing
resources have caused BSN programs
“80 by ’20,” continued
to reject tens of thousands of quali- structure of the country’s community grees. When the current funding cycle
ﬁed applications annually since 2004. college system could make it a major ends, the program will have produced
Reversing this trend will require more producer of BSNs, with sufﬁcient 2,200 new nurses from 108 partici-
public and private funding for fac- federal incentive money.* Although pating schools with an investment of
ulty hiring, student scholarships and baccalaureate degrees make up only more than $23 million. Graduates
loans, new clinical partnerships, and 1.5 percent of the Florida College are 38 percent male and 61 percent
resource-extending technologies such System’s educational output, says people of color. Because a majority
as simulation. Willis N. Holcombe, PhD, the system’s of graduates want to continue their
“We cannot, however, simply chancellor, they are expected to grow educations, AACN is developing a plan
expand what’s there,” says Kathleen in the next decade. to facilitate their educational progres-
Potempa, AACN president. “We must A proponent of educational pro- sion through doctoral degrees, says
think differently and let educational gression, Holcombe’s message to ADN Vernell DeWitty, PhD, RN, NCIN’s
redesign take us where we have never graduates is,“‘Congratulations, you National Program deputy director.
dared to go.” A joint AACN-AONE task are in the profession now but start Replicate Michigan’s Second-Degree
force is developing recommendations climbing the educational ladder.’ We Programs. Former Michigan governor
to bring the academic and practice need to give nurses opportunities for Jennifer M. Granholm committed $30
worlds much closer, driving excellence more education while working and get million to accelerated second-degree
in classroom and clinical education, more of them to take the next step.” programs and scholarships, which
says Potempa. together created 4,000 new nurses,
Expand the Availability of Community Up Accelerated Program Funding 3,000 new clinical placements, and
College BSN Programs. Could Florida’s Emulate New Careers in Nursing (NCIN). 277 new clinical instructors (2005–
14 community college BSN programs Funded by RWJF and administered by 2010).
be models for the nation? Some the AACN, NCIN allows students from
For More Information
nurse leaders are suggesting that the underserved or economically disad- • Visit www.aacn.nche.edu for more on NCIN.
geographic reach, moderate costs, di- vantaged groups to pursue acceler- *Aiken, L. 2011. Nurses for the future. New England
verse student bodies, and huge infra- ated second-degree BSN or MSN de- Journal of Medicine 364:196–98.
A Model Employer Incentive Program: North Shore–LIJ Health System
With 15 hospitals “More highly educated employees have a higher degree of
and more than conﬁdence that translates into better care. And they are
11,000 nursing posi- more comfortable in their practice area and more apt to take
tions, North Shore–
LIJ Health System
Maureen White, RN, MBA, CNAA, senior vice president and chief nurse executive, North Shore–LIJ
is one of the larg- Health System
est employers of Since the policy began in September advocates for
nurses in the country. It is also one of 2010, more than 80 percent of the going back. It
the most committed to encouraging system’s 500–600 annual nursing changes how you think and respond.”
educational progression, because its hires have had BSNs, and about half of In 2007, the system began offering
leadership believes more education hires with ADNs are pursuing BSNs. a doctor of nursing practice (DNP) de-
means better patient care. The system makes it as easy as gree in partnership with Case Western
“More highly educated employees possible to progress: it funds tuition University. Already 50 employees
have a higher degree of conﬁdence up front, has a generous release-time have graduated and another 23 are
that translates into better care,” says policy, and offers BSN and MSN com- enrolled. Enrollees receive full tuition
Maureen White, RN, MBA, CNAA, se- pletion programs on-site (directors of up front in exchange for signing a
nior vice president and chief nurse ex- nursing services and nurse executives two-year service agreement.
ecutive. “They are more comfortable must have the MSN). It also provides The system’s unlicensed personnel,
in their practice area and more apt to salary differentials for additional de- such as receptionists and housekeep-
take leadership roles.” To ensure the grees, although White believes that for ers, may pursue the ADN degree with
best-educated workforce, the system many the desire for more education full support (no service agreement is
has instituted a policy requiring new is a stronger motivator than money. required). So far, 60 have graduated
nursing hires to have a BSN or begin “We look for people with a thirst for and another 40 are enrolled. “It’s
work on a BSN within 18 months and knowledge. Those who go back for part of our commitment to lessen the
complete the degree within ﬁve years. more education become the strongest nursing shortage,” says White.
Enhance Diversity: Lessons from Successes at Duke University and the
University of California, San Francisco
Duke’s Welcoming Environment The Value of Gender Diversity
Nursing education has a poor record A Duke University undergraduate nursing stu-
dent practices injection skills on a simulation
of recruiting and retaining male stu-
dents. Only 11.4 percent of all under- The American Assembly for Men in Nursing
graduate nursing students are male; gave Duke a 2010 Best School for Men in
DNP and PhD percentages are 9 and Nursing award for its welcoming environment
and unusually high percentages of male stu-
7.5 percent, respectively (AACN, 2010).
dents, faculty, and staff.
Male students are often isolated be- Experts say that higher male workforce
Photo: Duke University
cause they lack faculty and staff role participation rates will help alleviate looming
models and mentors. Only 6.2 percent shortages of both nurses and nursing faculty,
give new attention to male health issues, and
of working nurses are men, as a result
be a boon to patient care.
of these and other factors.
It is no wonder then that Duke
University’s School of Nursing re- the university’s powerful team spirit, of existing faculty have completed
ceived a 2010 Best School for Men extends to its hospital system, which the modules. “It’s been wonderful
in Nursing award from the American is run by Kevin Sowers, RN, MSN, to watch the faculty grapple with it,”
Assembly for Men in Nursing (AAMN). and includes a nursing school dean, says Judy Martin-Holland, PhD, MPA,
Men make up 18 percent of its faculty Catherine Gilliss, DNSc, RN, FAAN, RN, FNP, associate dean, Academic
and staff—including three important “who cherishes diversity,” says Brion. Programs & Diversity Initiatives.
administrative positions—an aver- “Men entering an overwhelmingly Commitment to diversity in nursing
age of 15 percent of its undergradu- female environment develop ‘role practice is also a hallmark of UCSF’s
ate students, 20 percent of its DNP strain,’” says Brion. “They don’t know programs. “We are committed to
students, and 26 percent of its PhD how to act, and they don’t feel they serving underserved populations,”
students. belong.” Having numerous male fac- says Martin-Holland. “Applicants
The male student graduation rate is ulty and staff eliminates this strain. must show that they have experi-
not signiﬁcantly different from Duke’s Faculty do on-campus interviews ence serving these populations, and
remarkable 97.5 overall nursing with every potential enrollee to our students do clinical work in these
graduation rate, says assistant profes- ensure a good ﬁt. Nursing school out- communities and are expected to go
sor John Brion, PhD, RN, CHES. reach also speaks directly to men. For back out and serve them after gradu-
The key to Duke’s success is a wel- social support, Brion has established a ating.” As a result, the program has a
coming environment that begins with chapter of the AAMN on campus, and positive proﬁle in the community, and
every new male student is mentored diverse students gravitate to it, says
The Value of Cultural Competence by a more advanced male student. Martin-Holland.
Yet despite this positive buzz,
Photo: University of California, San Francisco
The University of California, and UCSF’s ﬁerce determination to
San Francisco Ensures Cultural maintain student diversity gains in the
Competence in the Curriculum midst of California’s four-year budget
To assist its entire faculty in paying crisis, diversity statistics for the doc-
more attention to diversity issues in toral program and the entry master’s
research, teaching, and clinical educa- program have dipped over the past
tion, the DIVAs (DIVersity in Action)—a three years, says Martin-Holland.
group of 20 faculty members who ad- “Accepted students of color often
vise the dean on diversity issues—did carry heavier debt loads than major-
a comprehensive review of all course ity students and will decide against
University of California, San Francisco stu- syllabi, course objectives, speakers, admission if their only option is to
dents and faculty, like those pictured above,
have beneﬁted from a major assessment and
and clinical education settings against take out more loans,” she says. “Ad-
revision of academic and clinical course cur- speciﬁc benchmarks, such as cross- ditional public and private funding for
ricula to ensure cultural diversity in content, cultural comparisons, social deter- student scholarships is needed.”
as well as speaker, patient, and preceptor minants of health, language barriers,
representation. The process was led by the For More Information
DIVAs (DIVersity in Action), a group of 20
power, and social construction.
• For more on the DIVAs and their online
faculty members who developed a six-mod- The DIVAs followed up with a six- diversity tutorial, write to mike.henseler@
ule, online training program to give faculty module, online diversity tutorial for nursing.ucsf.edu.
speciﬁc guidance. faculty. All new faculty and 60 percent
How to Double Doctorates by 2020
Figure 2 Trends in PhD and DNP Program Enrollments (2003-2010)
More doctorally prepared nurses are 6000
desperately needed to address pro-
jected nurse faculty and primary care
shortages, to advance nursing science, 2000 DNP
and to assume leadership roles of all PhD
kinds, says Michael Bleich, PhD, RN, 2003 2004 2005 2006 2007 2008 2009 2010
Both DNP and PhD enrollments are rising. Experts warn, however, that PhD enrollments will have to grow more signiﬁ-
FAAN, dean and Dr. Carol A. Lindeman cantly to ensure an adequate supply of nurse scientists and faculty in the future. Nursing PhDs and DNPs, as well as PhDs
Distinguished Professor, OHSU, and in nursing-related areas, count toward the doctorate metric.
Source: The chart was developed with data collected by the AACN.
member, IOM committee.
The rapid rise in DNP enrollments joint work on a research or leadership dents early in their careers. Although
since 2003, together with the growth project. Students also complete a the program is focused on research,
in PhD enrollments, puts the goal of paper and do a formal presentation on clinical experiences will be embed-
doubling doctorates by 2020 well the project. ded throughout, as will exposure to
within reach, says Geraldine “Polly” “For many, this is the turning point interdisciplinary perspectives, innova-
Bednash, PhD, RN, FAAN, CEO, AACN in deciding to pursue graduate studies tion, and health policy “to prepare
(for more, see Figure 2). and a faculty role,” says Long. The students as effective change agents
“The growth in DNP enrollments is school’s expectations of students also capable of transforming the delivery
impressive, and these graduates will motivate further study. “We tell them, of care,” says Mishan.
play very important roles in American ‘Yes, it’s important to be clinically The ﬁrst of at least three iterations
health care,” says RWJF’s Hassmiller. competent, but that’s not enough. We of the program begins in the fall of
“We must, however, increase PhD expect you to be leaders in changing 2011 at the University of Pennsylvania
enrollment growth to prepare more the current health care system.’” School of Nursing, with a renewable,
nurse leaders for faculty roles and to Many students are heeding the call. ﬁve-year $3,000,000 grant. Two addi-
advance science and discovery.” A quarter of undergraduate nursing tional universities will admit their ﬁrst
To achieve the IOM doctoral metric, students enter the honors program, cohorts in 2012. Once fully operation-
more nurses must begin doctoral and of those, 50 percent pursue al, the overall program will support
studies early in their careers, doctoral graduate studies within a year or 90 Hillman Scholars and graduate 18
programs must be expedited with- two, and more than 70 percent go on doctorally prepared nurses per year.
out loss of quality, scholarship and within three years. The Foundation program provides
loan support must be increased, and scholarships for a portion of basic
faculty compensation packages must Up Accelerated Program Funding nursing education and, with the aid of
become more market competitive. Incentivizing Early Recruitment and university matching funds, guarantees
Revised Curricula: The Hillman Scholars support for three years of full-time
Increase Graduate Admissions Program in Nursing Innovation. doctoral study.
Mentoring and Motivating Students: Scholarship support and expedited “We want beginning nursing stu-
The University of Florida Honors programs are also needed to speed dents to appreciate the power of
Program. Faculty mentorship is one the journey to and through doctoral nursing innovation to affect lives on
key to early identiﬁcation of talented studies. a grand scale through the redesign of
undergraduates, helping them deﬁne “Two years ago we saw the need whole systems,” says Mishan. “We are
career goals and pursue doctoral to help cultivate a younger genera- asking schools to alter the status quo—
studies without undue delay, says tion of nurse scientists, leaders, and to rethink their curricula.”
Kathleen Ann Long, RN, PhD, FAAN, innovators capable of inﬂuencing the The John A. Hartford Foundation,
dean of the University of Florida’s redesign of health care,” says Ahrin Gordon and Betty Moore Foundation,
College of Nursing. The college’s Mishan, executive director, Rita and Jonas Center for Nursing Excellence,
honors program, one of the old- Alex Hillman Foundation. In response, and other private foundations are also
est in the country, links individual the foundation will fund a streamlined actively advancing IOM goals.
students with a faculty member for BSN-to-PhD program targeting stu- Continued on page 8
“My wife, Mary, is a nurse. Her perspective has given me a deep understanding
of the critical role nurses play in our health care system and the daily chal-
lenges they face. To support the nurses that each of us depends on, we must
improve access to affordable education opportunities for ﬁrst-time nursing
students and working nurses returning to school.”
U.S. Senator Jeff Merkley, D-Oregon, cochair, Senate Nursing Caucus
How to Double Doctorates, continued
Replicate the Michigan Nursing Corps. oped faculty practice plans that gen- shortages and the implementation of
Former governor Jennifer M. Granholm erate substantial revenue for faculty the Affordable Care Act (ACA), says
established the Michigan Nursing salaries. Kenneth I. Shine, MD, executive
Corps to educate more clinical and Faculty typically generate money vice chancellor for health affairs, UT
classroom faculty (with $6.8 million for a plan either by holding joint aca- System, and former IOM president.
between 2008 and 2010). Participants demic-practice appointments funded Create Endowed Faculty Chairs. Schools
receive tuition and stipends in in part by employers or by providing of nursing are also pursuing foun-
exchange for signed agreements to primary care services on contract in dation funding for endowed chairs.
teach in Michigan nursing programs. an ambulatory clinic or other provider Although competition for the phil-
settings. Often faculty receive incen- anthropic dollar is tight and may be
Improve Faculty Compensation tive pay on the basis of the revenue constrained by foundation priorities,
Win Legislative Funding. Merely in- they generate or a bonus at year’s end “increasingly nursing is compelling to
creasing nursing doctorates will not if the plan has a proﬁt. The University private funders,” says Shine.
guarantee more nursing faculty unless of Texas at Houston (UTH) has a Sustain and Increase Funding. The
compensation packages are made particularly extensive practice plan. In American Nurses Association and oth-
more market competitive. Diverse 2010, its clinic gross revenues were ers are mounting a vigorous defense
state-level partnerships that include $1.9 million; its joint appointments against possible cuts to $500 million
business representation can develop accounted for $1 million. in ACA scholarships and education
enough clout to win big legislative ap- Because practice plans link the loan forgiveness funds designed to
propriations. worlds of teaching and practice in help newly minted faculty offset low
The Texas Workforce Shortage many ways, they are worth more faculty salaries.
Coalition garnered a $49.7 million than their weight in gold, says Geri The IOM report recommends that
nursing education appropriation from L. Wood, PhD, RN, FAAN, adjunct as- diploma programs be phased out
the Texas legislature that contained sociate professor at UTH. She teaches within the next decade and their
ﬂexible funding to boost faculty hiring evidence-based research at the resources—including graduate medical
and expand capacity in other ways university and helps nursing staff at education money—be used to expand
(2010–2011 biennium). the UT M. D. Anderson Cancer Center BSN and higher degree programs and
In Virginia, a “kitchen cabinet” of improve practice, with evidence from to support rural and critical access
advocates helped convince the leg- the latest research. In addition to nurse residency programs.
islature to fund a 10 percent raise for enriching both settings, “you become
For More Information
all nursing faculty in public colleges an ambassador for both,” says Wood, • Visit www.michigancenterfornursing.org for
and universities that has helped to who has inspired M. D. Anderson staff more on the Michigan initiatives.
create a 50 percent increase in nursing to return to school and her university • For details on the UTH nursing practice
plan, contact Thomas A. Mackey at
graduates since 2005. students to work at M. D. Anderson. email@example.com.
Develop Practice Plans. Some schools Practice plan opportunities will • For more on the legislative successes and
other innovations of state-level educational
of nursing, particularly those on expand dramatically in the next few capacity-building partnerships, download
health science campuses, have devel- years because of health workforce CNF 13 (May 2010) from www.rwjf.org.
“We must remove the unnecessary barriers that are discouraging so
many nursing students and working nurses from advancing their formal
educations. More ﬂexible work schedules, more seamless and efﬁcient
academic pathways, and increased access to accelerated programs of
proven value are sorely needed.”
U.S. Representative Steven LaTourette, R-Ohio, cochair, Congressional Nursing Caucus
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!"#$%&'()*+$,&'(-,).+%+$/ will switch to electronic Executive Editor: Maryjoan D. Ladden, PhD, RN, FAAN, Senior Program Ofﬁcer,
distribution in 2011, beginning with issue 17 (the Robert Wood Johnson Foundation
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Johnson Foundation and Director, The Future of Nursing: Campaign for Action
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Researcher and Writer: Jeri Spann, MPA, MFA, President, Spann Communications, LLC,
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Charting Nursing’s Future in the search engine box at Design: Spann Communications, LLC
the top of the page, and select desired entries listed Acknowledgments: A special thanks to the American Association of Colleges of Nursing and the
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