"Blowing Open the Bottleneck" in Oklahoma.

In June 2008 the first national Nursing Education Summit was held with 12 workforce development teams from across the country. The purpose of this two-day meeting was to showcase innovative "pioneering solutions" to the nursing education capacity crisis that is such a fundamental cause of the current nursing shortage. A white paper summarizing this important Summit and entitled Blowing Open the Bottleneck: Designing New Approaches to Increase Nursing Education Capacity has just been published and is the basis for this column.

We have been talking about and experiencing a shortage for so long that many of us may believe that we are surely in the middle of it by now and looking toward the end of it. Unfortunately, that is untrue. In fact, we are still on the cusp of the shortage with many experts predicting it will extend over the next twenty years. As observed in this important white paper, the future of American nursing "may well depend on the actions of today." To bring it home, the future of Oklahoma nursing depends on what we are doing about the bottleneck in nursing education today.

This is the clarion call for nurse educators and practitioners alike: act now to transform nursing education in ways that prepare more registered nurses with better qualifications and skills with which to approach 21st century nursing practice. Let me pose two questions to this readership. First, is there any way that doing "more of the same" or maintaining the status quo can resolve or weather this nursing shortage? Second, can we count on state appropriations, gifts, windfalls, or fairy dust for nursing education to increase dramatically enough over the next few years that little change in strategy on our part will be necessary? Said another way, can we hang on, can we "make do" long enough, that we won't have to kill sacred cows? Clearly, no matter how the question is posed, the answer is a resounding NO.

Four approaches to effective solutions were presented in the white paper. The first is Creating Strategic Partnerships to Align & Leverage Stakeholder Resources. The obvious stakeholders in the shortage are nursing education and practice settings, usually hospitals, and we have many examples of effective alliances between these two entities in Oklahoma. This approach, however, is suggesting a broader coalition of all stakeholders including consumers (or more specifically groups that represent consumers), companies that design or manufacture equipment or technologies used in nursing education and healthcare, workforce development agencies and others. Everyone with a stake in resolving this shortage ought to be at the table and contribute resources to align and leverage. The white paper, which can be found at http://www.chanpionnursing. org describes innovative partnerships across the country. Please read these from the standpoint of how we can implement them in Oklahoma.

The second approach is Increasing Faculty Capacity and Diversity. On this one, I believe we have made significant strides in Oklahoma. For example, we have had remarkable private funding for scholarships in nursing education that have stimulated much interest. We have added accelerated masters programs for nurse educators. Moreover, we now have multiple schools offering graduate programs leading to a master's degree in nursing education. We have addressed access issues with more programs and with flexibility added by online delivery. Most important in the long run, however, is that we now have doctoral education in nursing in Oklahoma. Contrary to what some want to believe or wish were true, we will not resolve the Oklahoma nursing shortage without access to doctoral education in nursing. Now we have it, and it must increase. In fact, Oklahoma City University is planning to begin their doctoral program in nursing in Fall 09.

Through an alliance between the University of Oklahoma and Integris Baptist Medical Center, both a continuing education workshop and a graduate credit course are available to assist staff nurses in assuming adjunct faculty roles. This is yet another example of stakeholders working together to increase faculty capacity.

The third and fourth approaches have to do with redesigning nursing education and flexing policy regulation. These approaches work together and so will be addressed together. An advantage in Oklahoma is that we have a Health Care Workforce Center designed to address shortages for all health professions, and we have IONE that focuses exclusively on nursing education or workforce preparation. Working together, these two organizations can fully address the nursing shortage as well as bring important stakeholders to the table. Ultimately nurse educators are responsible for curriculum redesign, however, the workforce center is immensely important through its emphasis on maximizing clinical resources, scholarships, new technology integration, and attracting the best and the brightest into health professions.

Many states have implemented curriculum redesigns that can serve as models of redesign as we move forward. The good news is that Oklahoma nurse educators have worked diligently for the past few years to put many of the pieces in place that can serve as a framework on which to build. For example, the Collaborative BSN Program (CBSN) is a partnership in which the junior year (30 credits) of the OU BSN curriculum is offered by a community college and students pay community college tuition which reduces the cost to the student roughly by half. Currently three community colleges, Tulsa Community College (TCC), OKC Community College (OCCC), and Northeastern Oklahoma A & M College (NEO) are partners in offering the CBSN program. Tulsa Technology Center (TTC) and TCC have a partnership (and there are others across the state) for a "one plus one" program in which TCC applicants may opt for this program and complete the PN program in year one and enter the bridge program (if successful on PN NCLEX) to complete the ADN program.

Course and faculty sharing and better integration of simulation, technology as well as clinical learning into the curricula are some of the innovations under discussion. It's an exciting and challenging time in nursing education. To assure success, we need every stakeholder to have voice. There is a place for you at the IONE table. Check out our website at http:// www.institute-one.org, and please become an active member. Let's all work together to build the preferred future for nursing in Oklahoma. The stakes are too high to fail.

Geraldine Ellison, PhD, RN Interim Executive Director, IONE