NURSE SUPPORT PROGRAM II Maryland Higher Education Commission

NURSE SUPPORT PROGRAM II Maryland Higher Education Commission & Health Services Cost Review Commission February 15, 2012 Peg Daw, NSP II, Office of Grants & Outreach, MHEC Oscar Ibarra, Chief, Information Management and Program Administration, HSCRC

State Snapshot

Relocation of MHEC ► Moved in renovated space on 1 st and 10 th Floors 11/15/11 Nancy S. Grasmick State Education ► 6 N Liberty Street, Building- 10 th fl Built in 1911 ► Baltimore, Maryland 217, 700 sq ft

Dr. Hal Cohen, HSCRC First Executive Director- Advocate for Nursing

Background on NSP ► The funding source for this program is an extension of HSCRC’s Nurse Support Program I (2001) which is designed to improve retention and recruitment of bedside nurses (2012). ► The NSP II (2005) was formed to mitigate a particular challenge in getting nurses prepared to work in hospitals by ensuring there are enough faculty to meet the demand. ► Overall the NSPI and NSPII programs, working together, clearly reduce hospital costs since nurses are the largest group of health professionals and represent nearly half of all hospital costs.

NSP II Funded Projects ► From FY 06 - FY 12 ► 67 Competitive Grants Awarded ► 25 SON Represented ► 0. 1% patient revenue of Maryland Hospitals ► Total Awards: $51 Million ► Total Expended: $36 Million ► Projected funds budgeted to 2018

15 MBON Approved RN Programs at Community Colleges ► ► ► ► ASSOCIATE DEGREE Allegany College of Maryland Anne Arundel Community College Baltimore City Community College Carroll Community College Cecil Community College of Southern Maryland Chesapeake College Community College of Baltimore County Frederick Community College Hagerstown Community College Harford Community College Howard Community College Montgomery College Prince George's Community College Wor-Wic Community College

11 MBON Approved RN Programs at Universities ► ► ► BACCALAUREATE DEGREE Bowie State University Coppin State University Johns Hopkins University Morgan State University Notre Dame of Maryland University Salisbury University Sojourner Douglass College Stevenson University Towson University of Maryland, Baltimore Washington Adventist University

25 SON Awarded by NSP II

New Programs and Initiatives ► Direct Entry MSN ► Certificates in Teaching ► Associate to Masters ► LPN to BSN ► EMT & Medic/Corpsmen to RN ► Accelerated 15 month Weekend ADN-RN ► New Undergraduate and Graduate Programs ► Doctor of Nursing Practice ► Increased On-Line Courses ► Increased Simulation Options

NSP II Competitive Grant Outcomes ► Direct Measurable Outcomes Reported: ► 1000 new RNs ► 300 BSNs ► 250 MSNs ► 71 DNPs ► 100 post-masters teaching certificates ► Indirect: new courses, improved retention, improved NCLEX rates, additional faculty, additional simulation and technology resources

Reflections

HSCRC is committed: ► To increase nursing education capacity► To educate, build and deploy the nursing workforce of the future in Maryland. ► Representatives from nursing education, GWIB, DLLR, business, hospitals and others are active in advocating nursing education & policy changes to address faculty shortages ► To increase nursing school enrollment and bring more nurses into the workforce.

NSP II- Nurse Faculty Careers ► Nursing Faculty is defined by the National League for Nursing Accrediting Commission (NLNAC) as “persons who teach and evaluate students and are academically and experientially qualified”. ► NSP II mandates “…a portion… be used to attract and retain minorities to nursing and nurse faculty careers in Maryland”.

Center to Champion Nursing. Educational Capacity ► Increasing faculty capacity and increasing diversity in faculty ► • Expand the education pipeline and addressing barriers to nursing education pathways. ► • Develop strategies to promote innovative educational models such as: § distance learning to bridge resources § dual academic/clinical exposure § year-round clinical options

Reflected in NSP II- Initiatives Increase support of nursing education by employers. • Improve work-life balance to improve recruitment. • Address the economic disincentives to becoming faculty, and determine how. ► • Solve high vacancy rates in clinical settings. ► • Increase numbers of tenure track faculty ► • Determine ways to resolve the insufficient supply of graduate-level nurses ► • Develop strategies to remove the gap between education and practice ► • Increase the limited pool for faculty recruitment. ► • Increase the pool of minority faculty. http: //championnursing. org/video/education-bottleneck ► ► ►

Educated Decisions Our lives are a sum total of the choices we have made. - Wayne Dyer

Future of NSP II ► Mature Program ► Initiated awards 2006 -07 for 10 years of funding ► Developed when NSP I exposed Educational Capacity and Nursing Faculty needs ► NSP I Evaluations Underway with Hospitals and Stakeholders ► HSCRC -Review Staff Recommendations in June, 2012 for possible renewal of NSP I ► Important to note NSP I & NSP II results

Landmark Report 2010

The Future of Nursing ► Dr. Donna Shalala, Ph. D. , current University of Miami president and former U. S. Secretary of Health and Human Services, “Transform the healthcare system to improve the nation’s health. The transformed system must be seamless, affordable, offers quality care that is accessible to all, patient-centered, evidence-based, and leads to improved outcomes. ” ► http: //www. youtube. com/watch? v=bql. Cg. U 5 Qglk&f eature=related ( 2. 3 -4. 3 - note interdisciplinary)

Impact of IOM-Strengthening Nursing Education ► Begin to Look at Opportunities and Learn to Think Very Differently ► http: //www. youtube. com/watch? v=jo. NI 3 Q 1 a. T 4 M (2. 0 - 6. 0 ~ 4 min) ► Joan Stanley, Ph. D, RN, CRNP, FAAN, FAANP, Senior Director of Education Policy, American Association of Colleges of Nursing

Maryland’s IOM SUMMIT Dean Janet Allan, hosted the first IOM Summit of Nursing Leaders on September 23, 2011, as Maryland became a regional action coalition. We cannot safeguard the long-term health of the U. S. population, nor stop health care costs from devouring our economy unless we make a significant investment in nursing education.

RN Workforce ► “There also continue to be a number of forces, both positive and negative, influencing the future nursing supply. ” On the negative side, . . increase in available seats. . , but qualified applicants. . turned away. . . On the positive side, …increasing the appeal of nursing and making entry more attainable. Accommodating people with degrees in other fields and accelerated degree programs have had an impact not anticipated a decade ago. ► “Whether our supply projections imply future shortages of RNs depends on estimates of future needs. “Auerbach, Buerhaus and Staiger (2011)

Educating Nurses: A Call for Radical Transformation ► The Carnegie Foundation for the Advancement of Teaching released the results of the first national nursing education study in 30 years. Educating Nurses: A Call for Radical Transformation (2009) explored the strengths and weaknesses in nursing education and the external challenges the profession faces.

Diversified Faculty ► Collaborate to recruit, develop, and retain a wellprepared and diversified faculty. ► Rationale: ► A sufficient supply of highly qualified nurse educators is the most critical factor in achieving successful educational outcomes. Insufficient numbers of nursing faculty has the potential to be the major barrier in educating sufficient numbers of highly qualified nurses. Current vacancy rates, the growing use of part-time faculty, and the looming retirement of the majority of nursing faculty all drive the growing crisis associated with the shortage of nursing faculty. (CINHC, 2008)

Maryland Statewide Commission on the Crisis in Nursing- 2005 Broaden options for interested nurses to become qualified to teach—teacher certification, education tracks at the master’s and doctoral level, etc. ► Recognize clinical practice as a valid route for faculty contribution in lieu of research and publication. ► Develop a mechanism for central advertising using a shared Web site for the posting of full-, part-time, and adjunct positions. ► It is recommended that MBON monitor faculty vacancies on a regular basis and report them at least annually in its public report. ► http: //www. mbon. org/commission/nsg_faculty_shortage. pdf

AACN Maryland Report 2012

Aging Faculty in Maryland- AACN

Ph. D trends in Maryland-AACN

Faculty Development ► The combination of lack of basic teacher preparation in graduate nursing schools and limited faculty development conspires to thwart the scholarship of teaching in nursing. ( Carnegie Study, 2009) ► June 2011 Maryland Deans and Directors recommended: Certificates in Education, Preceptorships, Mentor updates, increased Doctoral options and time to complete

HSCRC -Investing in Educators ► Significant resource investment is required for novice-to-expert development of highperforming nurse educators: preceptors, mentors, clinical instructors, early- and midcareer faculty, and nursing education executives. (CINHC, 2008) ► NSP supported by 48 Maryland hospitals ► ~$13 mil budgeted for NSP II FY 2013 ► ~$ 5 mil budgeted for NSP II Phase 7

Faculty Recruitment & Retention ► Barriers to faculty recruitment, retention, and satisfaction include disparate salaries, inflexible schedules, increasing workloads, and limited career mentoring. NSP II Statewide Initiatives address these: Mentoring Relationships ► Plans of Study that include Education Core ► Advanced degrees for faculty infrastructure ► New Nurse Faculty Fellowship ►

Connecting the Program Dots

RNs most trusted profession ► Trust your hunches. They’re usually based on facts filed away just below the conscious level. – Dr. Joyce Brothers

Synergy for Impact- Rich Traditions ► The University of Maryland School of Nursing & Johns Hopkins Hospital and the nursing training program, founded in consultation with Florence Nightingale, both opened in 1889 and are two of the oldest in the country. The first nursing school in the US opened in 1873. ► Celebrating 120 years of Nursing in Maryland

Who will take the lead? 1. Develop a faculty workforce plan- to determine faculty needs, to educate nurses and optimize utilization of limited faculty resources. ► 2. Implement innovative solutions to address faculty salary disparities. Determine impact of freeze on wages- increasing contractual and adjunct use & sustainability ► 3. Promote nursing education as a desired career path. ► 4. Assess and evaluate faculty development activities. Promote a statewide standard. ► 5. Develop open access web-based faculty resources, openings, registry, etc. ► 6. Implement remaining Maryland “Nursing Faculty Shortage” recommendations and evaluate progress

Regional and Statewide Solutions ► A region is a collection of assets —human, financial, institutional, and natural among others—that are coordinated towards a shared purpose, transcending boundaries, to unite individuals and organization that share common interests and goals. Capacity, collaboration and coordination are keys to developing a regional approach. ► Identify your region, create a shared vision, develop strategies and leverage resources. ► Consider partners at state, regional & local levels.

Governor’s Workforce Investment Board- Health Care 2020

Primary Care Workforce Strategic Plan ► Released November 2011: includes APRNs ► Can NSP II utilize model for faculty?

IOM Future of Nursing Report 2010 ► Recommendation #8 - Build an infrastructure for the collection and analysis of inter-professional health care workforce data. ► The Workforce Commission and the HRSA should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor should work together for data sets. ► Find common ground and mutual missions

Ongoing Faculty Development ► Support robust, ongoing faculty development for all who educate student nurses. ► Individual teachers, programs, institutions, state boards and professional societies should convene with the aim of (1) enhancing the practice of teaching in the profession; (2) improving faculty development incentives and rewards for good teaching; and (3) developing curricula and strategies that foster lifelong learning and clinical inquiry skills in student nurses. Educating Nurses- A call for Radical Transformation, Carnegie, 2009 ► IOM Future of Nursing, 2010 Recommendation #6 ►

Address repeating refrains ► Efforts to recruit students into graduate programs that could lead to teaching positions will continue to be futile unless faculty salaries are increased and brought into line with clinical salaries and teaching positions in other disciplines. Health care organizations, nursing schools, public and private institutions must come to agreement and be forward-thinking in their personnel policies. ► (Carnegie Foundation, 2009) ( AACN, 2011) ► (GWIB, 2011) ( IOM Committee #5 Survey, 2011)

National League for Nursing Position On The Value of Certification ► Certification in any field is a mark of professionalism. For academic nurse educators, it establishes nursing education as a specialty area of practice and creates a means for faculty to demonstrate their expertise in this role. ► It communicates to students, peers, and the academic and health care communities that the highest standards of excellence are being met. By becoming credentialed as a Certified Nurse Educator (CNE), you serve as a leader and a role model. ► http: //www. nln. org/certification/index. htm

2012 FY -Top Rated Projects ► Key Reasons 1. Clear and concise 2. Budget- institutional match and conservative approach 3. Incremental objectives by yearintervention specific 4. Strong evaluation plan- including data base or broad framework that all partners and possibly all SON could access 5. Letters & MOU from partners Focused Need Regional Faculty Academy and Mentorship Initiative Community College Student Increasing Retention, Success and Graduation University Preceptor and Clinical Faculty Development Simulation- scenarios, opportunities, extension

Common Sense Success ► Success is more a function of consistent common sense than it is of genius. – An Wang. Merriam Webster describes it as ”sound and prudent judgment based on a simple perception of the situation or facts” ► www. bhspreservation. org ►

Share ideas Extend Regional Faculty Academy & Mentoring Extend Simulation and Web based Scenarios Extend Student Success and Retention Models ► Develop Statewide Database for New Faculty & Mentors ► Faculty Excellence in Education ANCC Practice Certifications & NLN Certified Nurse Educators ► Research-trend and track graduations based on qualifications of faculty and investment of mentors ► Develop shared technology- apps, scenarios, etc ► Seamless transitions between RN-BSN-MSN-DNP/Ph. D ► Define and defend- DNP prepared educators ► Partner with agency(s), institution(s) or profession(s)- advancing compatible concomitant missions & success ►

Great Educators = Great RNs ► Nursing Educators play a vital role in the development of the nursing profession. They lay the foundation for how nurses practice and interact with patients, families, communities, fellow nurses and other health care professionals. They model ethical decision making, critical thinking, caring and professional behavior.

Positive Reports- Replicable Model

Department of Legislative Services - 2. 8. 12 ► MHEC should comment on what has led to NSP II’s success and if a replicable model. ► 2001 -2013 Master’s and Doctoral Nursing Degrees Conferred (2001 - 294, 2007 -329 ► 2009 -344, 2011 -505, 2013 projected 568) ► 3 Pronged approach- Institutions, GNF, NNF ► High level of stakeholder collaboration ► Well publicized need, committed funding

‘Doing the Doable’ Sims describes this Experimental approach as “little bets” or low-risk concrete actions taken to discover, develop, and test ideas that are achievable and affordable. “generating ideas… based on building up solutions, rather than starting with the answer. ” Successful big thinkers from across industries used this principle in their work- it’s particularly valuable when navigating uncertainty, creating something new or attending to open ended problems.

'Nurse Net' app gives nurses a digital boost When Apple accepted his app in November, Robert “Robbie” Freeman said he would have been happy if 1, 000 people downloaded it in the first year. ► A little over 60 days later, more than 12, 000 people have downloaded Freeman’s “Nurse Net” app free, and the 26 -year-old registered nurse, former Long Island Athlete of the Year (2003) long distance running, is committed to helping others: after completing nursing school he spent three weeks with an American medical team doing free work in rural Kenya, East Africa. ► ► “. . really have embraced apps, but there are not a lot of them out there for nurses, even though nurses make up the largest group of health professionals in the country. ” ► http: //itunes. apple. com/us/app/ nurse-net/id 477632231? mt=8 ► ► CLEM RICHARDSON, NY Daily News Monday, January 30, 2012

Sea of Change ► Nurse execs and faculty and staff nurses and managers and students all need to talk to each other. We need to talk about where is nursing going, about what leaders need to do, about the science behind how we care for people. We need to help nursing find its voice and we need to make that voice heard. Marie Manthey, RN Consultant ► Creator of nursing salons-thoughtful conversations about nursing. http: //news. nurse. com/article/20120206/IL 02/102060007

Tide and Time

Application Requirements ► Needs Assessment ► Identified Project- clearly stated ► Goals and Objectives- progression ► Plan of Operation ► Implementation ► Evaluation- measurable outcomes ► Budget- clear and conservative ► Reports- timely, electronic & paper ► Outcomes affect people and are the reason to do something

Program Outcomes= Direction Performance indicators and outcomes are measurable consumer-oriented indexes designed to evaluate the degree to which the program is achieving its mission. ► Focus, Design, Collect, Analyze, Report, Use Graduate Nurse Scholarship Program Modifications-- Maryland data from DLLR, MBON, MHA, AACN, IOM Future of Nursing Report, Leadership of Maryland Deans and Directors, Faculty & Graduate Nurse Surveys and personal interviews with awarded students, HSCRC & MHEC guidelines and legal statutes Economic incentives should run to outcomes. ►

HSCRC Modifications ► 1. GNF Scholarship Award ► Cover all Tuition and Fees ►Remove 2 year time limits ►Include Nursing Education Certificates ►Include Doctoral Education ►Commemorate Dr. Hal and Jo Cohen ► 2. LEG- deemphasize to prioritize tuition ► 3. New Nurse Faculty Fellowship-no change ► 4. Remove LARP- not part of NSP II ► 5. Include Doctoral Dissertation research

Our Expectation ► HSCRC and MHEC view this stage of the work of NSP II from a broader perspective. Moving from disconnected islands of innovation in all 26 nursing programs to a systematic and coordinated statewide effort for nursing education- faculty, infrastructure and outcomes- that improve the safety and quality of health care for Maryland through sustaining faculty and bedside RNs.

Phase 7 RFA for FY 2013 ► http: //mhec. maryland. gov/grants/nspii . asp ► Review application process with group ► Packet ► Highlight any changes ► Evaluation

Questions

Next Steps ► NSP II application deadline 4/9/12 ► Competitive Grant Awards Released in June ► Previous Institutional Grants ► Extension Requests due 5/31/12 ► Annual Reports due 7/31/12 ► Final Reports due 9/30/12

Contacts ► Peg E. Daw (MHEC) § (410) 767 -3372 § pdaw@mhec. state. md. us ► Oscar Ibarra (HSCRC) § (410) 764 -2566 § oibarra@hscrc. state. md. us

References American Association of Colleges of Nursing, 2010 - 2011 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing Report http: //www. aacn. nche. edu/media-relations/fact-sheets/nursing-faculty-shortage Auerbach, D. I. , Buerhaus, P. I. , & Staiger, D. O. (2011). Registered nurse supply grows faster than projected amid surge in new entrants ages 23 -26. Health Affairs, 30(12), 2286 -2292. http: //search. proquest. com/docview/910128667? accountid=10639 California Institute for Nursing and Health Care, (2008) Collaboratively Creating an Emerging Future for Excellence in Health Care Through Excellence in Nursing Education. http: //www. cinhc. org/wordpress/wp-content/uploads/2009/12/5_Nursing-Ed. Redesign. pdf http: //www. cinhc. org/2010/05/education-redesign-building-blocks-illustration/

References Benner, P. , Sutphen, M. , Leonard, V. & Day, L. (2009) Educating Nurses: A call for Radical Transformation, The Carnegie Foundation for the Advancement of Teaching Series, Jossey-Bass, San Francisco, CA. Governor’s Workforce Investment Board Report (2011) Preparing Maryland’s Workforce for Health Reform: Health Care 2020 http: //www. mdworkforce. com/ Health Services Cost Review Commission http: //www. hscrc. state. md. us/init_nsp 2. cfm Institute of Medicine, (2010) report, The Future of Nursing: Leading Change, Advancing Health. http: //www. iom. edu/Reports/2010/The-Future-of-Nursing-Leading-Change. Advancing-Health. aspx

References Maryland Board of Nursing, Nursing Faculty Shortage (2005) http: //www. mbon. org/commission/nsg_faculty_shortage. pdf Maryland Higher Education Commission http: //mhec. maryland. gov/grants/nspii. asp National League for Nursing Accrediting Commission http: //www. nlnac. org/home. htm Nursing Education Capacity Summit (2008) Final Report, Center to Champion Nursing, RWJ http: //championnursing. org/sites/default/files/1693_Nursing. Summit. Report. FINAL. p df

References Sims, Peter (2011 ) Little Bets: How Breakthrough Ideas Emerge from Small Discoveries, Free Press Simon and Schuster, New York, NY www. petersims. com