ANALYZING NURSING WORKFORCE DATA TO DESIGN NURSING EDUCATION STRATEGIES TO MEET THE EXPANDED HEALTHCARE NEEDS OF THE FUTURE The National Forum of State Nursing Workforce Centers June 11, 2015 Virginia D. Ayars, EdD, MS, RN, CNE, Texas Board of Nursing Pamela Lauer, MPH, Texas Center of Nursing Workforce Studies

Purpose Assess how data collection assists in the tracking and implementation of state-based nursing education initiatives aimed at expanding and improving the nursing workforce.

Learner Objectives Describe the impact of data in designing education models to increase the number of nurses enrolling in advanced degree programs. Discuss recommendations for quality improvement in clinical instruction based upon data, literature findings, and dialogue among experts.

Collaboration Texas Center for Nursing Workforce Studies (TCNWS) Texas Legislature created TCNWS in 2004 Educational and employment trends Supply and demand trends Nursing workforce demographics Migration of nurses

Collaboration (cont.) Texas Board of Nursing (BON) Mission Licensees in Texas 250,000 RNs 96,000 LVNs Nursing Education Programs 117 Professional Nursing Education Programs 1 Diploma 69 Associate Degree 47 Baccalaureate Degree 93 Vocational Nursing Education Programs 24 Advanced Practice Registered Nurse Programs

Process of Development and Revisions of Two Data Instruments Nursing Education Program Information Survey or NEPIS Compliance Audit for Nursing Education Programs or CANEP

Samples of Data Reports Developed by TCNWS for state legislature Provide evidence for funding formula decisions and faculty loan repayment programs

Accepting the Challenge IOM Recommendation to increase BSN-prepared nurses to 80% by 2020 RN-to-BSN Programs (32 programs in 2014) RN to BSN Fact Sheet Academic Progression in Nursing (APIN) Grant Program

Methods for growth Increase the number of ADN graduates enrolling immediately following graduation in RN-to-BSN programs Encourage those already in practice to return to school for the BSN APIN Grant focus: Increasing enrollments Monitoring progress through data collection and analysis

Data to Track Academic Progression In academic year 2014, 2,902 RNs graduated from Texas RN-to-BSN programs. Nursing workforce data and BON licensing data can be used to determine: Total number of RNs needed by 2020 (demand projections) Current breakdown of nurses by highest degree (licensure data) Number of students enrolling and graduating from RN and RN-to-BSN programs (education data)

Sub-goals and Tactics Develop policy strategies Increase diversity in nursing workforce Demonstrate alignment and collaboration between practice and education Implement APIN II Grant Develop a faculty student distance model using technology Provide leadership Create and deploy tool box for faculty

New Curriculum Model Consortium for Advancing Baccalaureate Nursing Education in Texas or CABNET model to promote mobility into advanced degree programs

CABNET Objectives Expand the number of CABNET agreements between community colleges and universities Expand number of programs participating in concept-based curriculum to 15. Develop, implement, and evaluate faculty development programs

CABNET Objectives (cont.) Use a focus group methodology to assess employer and regional leaders’ perceptions of behaviors demonstrating competence of the “nurse of the future” especially for IOM concepts Increase the percentage of RNs who are ethnic minorities by 5% of 2014 baseline number Document the employment policies used by partnering clinical sites that support academic progress for nurses Develop a process to document the number of Texas ADN graduates immediately enrolling in BSN programs Develop a process to document the number of graduates from out-of- state RN-to-BSN programs

Concept-based Curriculum Concept is an organizing idea, principle or unifying classification Sustainable Universal Attributes (characteristics) Defining attributes are rules or parameters

Conceptual Learning Focusing on big ideas – concept Linking concepts to exemplars for content knowledge Linking to inter-related concepts Fostering deep learning, and deep understanding through connections and reflection (as opposed to surface learning) Using clinical context as a foundation for student-centered learning with a purpose

Positive Aspects Allows for deep learning of concepts Content management Maximizes efficiency Prevents content saturation Application to key exemplars Variety of clinical settings

Texas CBC Professional Nursing Concepts Health Care Concepts Clinical Judgment

Future Monitoring Program Effectiveness can be monitored through: Program track data (education data) Enrollment, graduation, and admission numbers (education data) Workforce race/ethnicity data (licensure data) Student race/ethnicity data (education education)

Using APRN Data Provide readiness through data to meet the needs of the ACA Establish an APRN database Reflect enrollment and graduation trendi ng

Recommendations for Quality Improvement October 2011 Charge to BON Task Force to Study Implications of Growth in Nursing Programs in Texas Create a forum for dialogue Ensure state will continue to provide quality nursing education

Products Two new Education Guidelines Precepted Clinical Learning Experiences Utilization of Part-time Clinical Nursing Faculty Two new charges issued to Task Force at October 2013 Board meeting Develop guideline re. optimal clinical instruction Provide analysis of findings from 2013 NEPIS re. required clinical hours

Collection of Data Online Task Force Survey BON Survey Texas Team Clinical Placement Survey TAVNE Survey 2013 NEPIS Reports

Application of Data Task Force Monograph Towards Defining Excellence in Clinical Instruction in Pre-licensure Nursing Education Programs

Ten Criteria 1) Patient Safety is fundamental to every student patient encounter. 2) Sufficient opportunities are provided for students to apply knowledge and skills. 3) Faculty have the authority to plan, supervise, and evaluate the clinical experience. 4) Faculty provide coaching and positive feedback to students consistently. 5) Clinical experiences are provided in a variety of clinical settings.

Ten Criteria (cont.) 6) Opportunities are provided for faculty to guide clinical decision-making by students. 7) Evaluation tools are used to document student performance and promote growth. 8) The program supports opportunities for faculty skill development. 9) Clinical evaluation tools reflect competencies in the Differentiated Essential Competencies for Graduates of Nursing Education Programs in Texas (DECs). 10) Simulation activities are provided that mimic reality of the clinical setting.

Recommendations Programs Support faculty development. Provide adequate orientation to new faculty. Evaluate the use of preceptors, possibly reserving for a capstone course. Emphasize the importance of relationship building among faculty, students, and clinical partners. Evaluate whether faculty-to-student ratios promote patient safety.

Recommendations (cont.) Faculty Carefully plan time in the clinical setting. Consider other venues for pre- and post-conferences. Review and revise clinical evaluation tools to provide a formative and summative evaluation. Seek ways to enhance the use of skills and simulation laboratories. Ensure that clinical experiences are planned to meet clinical objectives. Seek supplemental learning activities for medication administration and documentation. Model positive characteristics of respect and caring.

Recommendations (cont.) Students Take advantage of strategies to engage in active learning activities to fully gain the knowledge, skills, and abilities essential to safe, competent nursing practice. Express positive characteristics of respect and caring to peers, faculty, and patients.

Recommendations (cont.) Clinical Partners Patient safety foremost factor in clinical placement of students. Consider allowing faculty to participate in opportunities for clinical skills development. Contribute to relationship building among faculty, students, and clinical partners. Engage in dialogue with education programs to clarify joint expectations for preceptor roles, clinical objectives and clinical supervision. Assist the programs by providing feedback regarding the clinical learning experiences.

Major Outcomes Data instrumental in monitoring progress re: 1) increasing nurses with BSN degrees 2) increasing minorities in nursing 3) a pilot project that implements a Concept-Based Curriculum Model designed for ease of mobility into a BSN program 4) increasing APRN enrollment 5) using more clinical time in simulation to free space in clinical settings among pre-licensure nursing programs

Conclusions Efforts for growth and quality improvement are based in part upon workforce data and will rely upon data for evaluating the effectiveness of new strategies and planning for the future.

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