The Academic Progression in Nursing Program (APIN) has concluded a four-year project to identify and develop the most promising strategies for creating a more highly educated nursing workforce. APIN was funded by the Robert Wood Johnson Foundation (RWJF) in partnership with the nursing Tri-Council, and was administered by the American Organization for Nursing Leadership (AONL). The APIN National Program Office (NPO) selected nine states to design and test potential models of academic progression to support increasing the number of nurses with a baccalaureate degree to 80% of the workforce, as recommended in the IOM report, The Future of Nursing: Leading Change, Advancing Health. Representatives of these nine states were subsequently linked through the NPO with other thought leaders nationally to incorporate learnings and distill the most promising strategies.
This group collectively identified a model which shows the greatest potential for gain in advancing seamless academic progression. The model centers on intentional and carefully constructed partnerships, and builds on the existing infrastructure of widely available community colleges as well as university expertise for providing baccalaureate education. APIN grantees and other innovators developed a number of variations on this partnership model, demonstrating that it is sufficiently flexible for adaptation across a broad landscape. Although individual project sites used differing mechanisms to advance the model, there is substantial commonality across the group, allowing some comparison and preliminary evaluation of promising practices.
Key elements of successful partnership models include alignment of curriculum and specific aspects of supportive infrastructure, which the group has defined and explored. All participants recognized that close collaboration and support from practice partners is critical to success, and many worked to develop mechanisms to foster these relationships.
Partnership models exist on a continuum of increasing curricular integration and infrastructure, and more information is needed to identify where within that continuum the most effective and efficient pathway lies. Due to the time required to design and implement academic programs, early adopters are only now seeing sufficient cohort size to allow meaningful evaluation.
The proportion of students who progress directly from Associate Degree (AD) to the Bachelors of Science in Nursing (BSN) varies across project sites. Most with integrated progression pathways report that when students within these programs who complete the AD component, over 80% will advance directly into the BSN component. This represents substantial improvement over levels of progression in systems without intentional partnerships, and is a remarkable achievement over a short period of time. However, early results indicate that even well-designed partnership models will not achieve an 80% BSN prepared nursing workforce unless students are incentivized to enter and complete the baccalaureate curriculum through specific aspects of program design and focused efforts on the part of nursing employers.
The APIN program has generated extensive information and exemplars to support further development and dissemination of partnership models, but momentum must be maintained to achieve the desired outcomes and prevent a repeat of historical patterns in which educational emphasis varies with market forces. It is critical that national nursing leaders broaden impact of these learnings through
- Ongoing centralization of resources, expertise and collaborative learning.
- Continuing dissemination of information on the need and options for academic progression programs.
- Supporting development of standardized metrics for data collection and evaluation.
- Deepening engagement with Deans and Directors of all nursing education programs, not just with those already engaged with academic progression models.
- Fostering consistency and continued support of practice partners and nursing employers, especially those in rural areas or smaller health care systems and settings.
The nursing profession has been mired in controversy over nursing education for more than fifty years. Registered Nurses (RNs) are seeking baccalaureate education in record numbers, resulting in small but steady advances in the proportion of BSN educated nurses within the workforce. However 50% of RNs continue to enter the workforce through the community college pathway and achieving the IOM recommendation goals will require facilitating a greater proportion of these nurses directly into BSN education.
The APIN grantees and other national leaders have identified a viable model to successfully realize that outcome. Additional steps are required to bring this work to fruition and achieve the intended goals.