Editor's note: Jennifer Graebe is the director of nursing continuing professional development and joint accreditation at the American Nurses Credentialing Center, and Lisa McIntyre-Hite is vice president of learning innovation at Guild Education.
Two years into the COVID-19 pandemic, America's nursing shortage is well established. What's less understood is how higher education can help to stem the crisis.
America's nursing crisis is embedded in our daily conversation: in nightly news coverage, social media posts and countless heart-wrenching stories about staff burnout and mounting pressure on healthcare systems. Retention strategies alone will not account for the pre-Covid estimate of 1.2 million nurses America is projected to require by 2030.
The need for RNs is so prodigious that nursing programs are unable to serve and graduate nearly enough students to address America's growing nursing shortage. Last year, schools of nursing were forced to turn away roughly 80,000 qualified applicants.
Compounding this problem is a widespread lack of diversity in the field: According to the National Council of State Boards of Nursing, roughly 81% of nurses are White, and this overrepresentation translates into health disparities for racial and ethnic minorities and underserved patients.
The scope of the problem calls for a different solution, and this is where learning institutions can play a critical role.
By adapting new tactics, building more flexible ways to credential new nurses and making academic progression more accessible through stackability, learning institutions can take critical steps to strengthen America's core of nurses.
An overlooked and equitable solution is to serve a population of working adults who have a desire to enter the nursing profession and are already employed by healthcare organizations. These employees — and future students — represent greater diversity than the current nursing population and they represent a talent pool to meet a critical moment for our nation's healthcare system.
Here are some ways that academic nursing programs can embrace innovative learning practices that support this effort.
Competency-based education is an impactful methodology that prioritizes student learning over time spent in the classroom. Programs are designed to help students master specific competencies that tie directly into their desired future careers, and these learning outcomes are clearly communicated to students prior to enrollment and reiterated consistently throughout.
This transparency, combined with hands-on coursework to prove mastery, can equip RNs to enter the field more prepared to practice, and provide healthcare organizations with clearer expectations of the capabilities of their newly minted RNs.
CBE programs are also inherently flexible, as they do not seek to mandate when and how learning takes place.
"It works well for the lives of students," said Nicole Simonson DNP, RN, director of RSN-to-BSN completion programs at the University of Wisconsin-Milwaukee. "The program is flexible so they can self-pace and take on bits and pieces when they are available."
Students are not forced to choose between work and school when their hours are unpredictable, or miss a parent-teacher conference for an exam. This flexibility can be reassuring and instill a level of confidence that success is attainable.
Numerous organizations, including the ANCC, AACN and C-BEN have worked to define key competency expectations for nurses, and develop a framework to ensure quality and rigor from formal education through professional development and beyond. This demonstrates a recognition within the field that healthcare team members need the tools and resources to provide competent and high-quality care as well as opportunities for role advancement.
Making those opportunities accessible requires partnerships between practice-based and academic settings to create innovative models of education and learning that capture on-the-job learning, can be translated into academic credit, and support the creation of individualized academic plans with competency mapping for employees as prospective students.
Credit for X
Learning can happen anywhere. Institutions that are able to measure and qualify classroom and on-the-job learning, and provide students with credit for it will ultimately attract more working adults and equip them to move through programs more equitably.
In fact, Guild research with one employer partner found that one in five students would not be in school today without the opportunity to transfer their on-the-job learning for credits.
"It was really cool to be able to count my on-the-job training as credits for school because in the long run it saved me time and it saved me money potentially," one Guild student said. "It kind of showed me that what I was learning on the job was actually applicable to my degree."
Sixty-five percent of frontline healthcare workers said they want to pursue clinical, advanced clinical or healthcare management roles in a recent Guild survey. This is an untapped population of future RNs who may begin nursing school with relevant experience and skills. Many already have an allied health certificate, or on-the-job training that has resulted in mastery of specific nursing competencies.
Credit for existing competencies avoids redundant learning, and can therefore accelerate program completion. If we assume students enter their nursing program with even 15% of the competencies taught, acknowledging this learning with credit effectively empowers schools to educate 15% more of the about 80,000 qualified applicants that were turned away in 2019 due to lack of capacity — or 12,000 more RNs.
Any degree can be broken down into its requisite parts. Acknowledging that not every part must happen sequentially, or in the same place, creates a system in which all high quality, verifiable learning can stack into a degree.
This creates easy on- and off-ramps for students, as well as opportunities for learning to occur in smaller portions, which is the preference for time and cash-strapped working adults. With every new credential, a student is able to access a new job opportunity or salary bump and fill a high priority role for their employer, while setting themselves up for the next step tomorrow; an accessible pathway to their BSN.
If credentials become fully stackable, a medical assistant who ultimately aspires to be an RN can choose to enroll in, for example, a phlebotomy program as a first step. Once she passes her certification she will be able to continue working at the same hospital but in a new capacity and with an increased salary — two qualities essential for retention. Furthermore, when she is ready to enroll in her ADN or BSN program, she can return to the school where her work in the certificate program will count towards her degree, and she will be able to graduate sooner.
What's not in doubt is the need: Our country needs more RNs and a more diverse workforce to serve our communities. Solutions designed to support equitable access and outcomes for working adult students, who represent a mature and diverse prospective student group, can provide schools of nursing with a pathway to serve more students without sacrificing quality.
As more healthcare organizations provide their employees with education benefits, the schools of nursing that adopt purposefully-designed opportunity pathways to serve this growing student population stand to lead the ecosystem in sustainable solutions to bring more talented, representative RNs into the healthcare field — and to play a critical role in addressing a national crisis.