The Path Forward


Extensive work remains to more fully evaluate these very new programs, continue dissemination of findings, and support expansion of successful programs.   The academic progression projects have not yet demonstrated sufficient momentum to allow the process of national education transformation to be self-sustaining.  Academic progression in nursing overall has benefitted from increased attention, new programs, and employer demand.  '

However, nursing education has a lengthy history of response to market forces, including the reduction of educational requirements in response to labor shortages (Donley & Flaherty, 2008).  Current market projections for nursing vary from supply outpacing demand (United States Health Resources and Services Administration National Center for Health Workforce Analysis, 2014) to a continuation or worsening of the nursing shortage (Carnevale, Smith, & Gulish, 2015).  The extent to which education transformation might be “undone” by a market shift is unclear but concerning.  A retreat from the progress to date creates a risk of perpetuating nursing’s fifty year stagnation on the issue of educational preparation for practice.  Nursing leaders must collaborate and form an effective response to this potential threat. 

Consolidating and continuing current gains will require continued centralization of this work in the immediate future, to allow comparative evaluation of outcomes, identify the most cost effective pathways, evaluate impact on diversity, and relieve expensive redundant efforts by individual schools redesigning education pathways.

Needed next steps

The APIN NPO recommends the following specific actions to bolster progress to date and reach the identified goal of 80% of the nursing workforce prepared at the level of the baccalaureate and beyond.

  • Complete dissemination of findings to date.
    • Continue development of a web-based repository of information.
    • Expand efforts to message through publications and presentations.
  • Determine a central point and organization/s for the ongoing work to convene, coordinate and facilitate academic progression efforts nationally. 
  • Standardize data metrics specific to evaluating outcomes of academic progression pathways.  Assess which programs are most successful at getting and keeping students in the baccalaureate pipeline and determine impact of statewide transfer agreements and other methods.  Create replicable metrics to evaluate individual models’ enrollments, progression, and graduation rates, including diversity data at all points of measurement.
    • Develop replicable metrics for reporting the number and proportion of AD students who advance directly to the BSN or remain within a fully integrated pathway program.
    • Develop replicable metrics for reporting the number and proportion of AD students who return for the BSN within a defined period (1-2 years).
    • Centralize data into a repository for evaluation.
  • Develop a standardized method for evaluating impact of innovative academic progression pathways on diversity.  Address any trends related to loss of diversity within innovative academic progression pathways.
    • Evaluate impact of inclusive mechanisms of student recruitment and support structures such as mentorship.
  • Complete an environmental scan to identify other examples of the partnership model in place or under development.
    • Evaluate the total number and characteristics of co-enrollment models or other similar initiatives.
    • Identify LPN - BSN or medic - BSN pathway options that would benefit from links to work in progress.
  • Improve coordinated outreach to Deans and Directors of nursing programs nationally.
    • Expand outreach beyond the CFA Action Coalitions through statewide Deans and Directors group to assure adequate inclusion.
    • Incorporate the resulting broadened constituency in future discussions and strategic planning.
    • Strengthen roles of national organizations devoted to nursing education, assuring institutionalization of the mission of academic progression.
    • Develop a structure of guidance for schools of nursing across the U.S. seeking to advance to more efficient and effective partnership models to assure that all nursing students entering a community college pathway have access to seamless progression to the BSN.
  • Continue strengthening the role of practice partners.
    • Assure continued collaboration on curricular development to assure employer needs are addressed, especially the education of nurses for new roles outside of acute care.
    • Strategize adaptation to market shifts to prevent loss of progress.
    • Assure institutionalization of support for academic progression within practice settings.
  • Further evaluate the impact of messaging and recruitment on the number and proportion of prospective students who select into the AD vs BSN pathway.
    • Messaging requires nuance in view of the evidence linking patient outcomes to nursing education level and prospective students require accurate and complete information.
    • Offer successful methods of messaging and recruitment to new programs.