Oregon colleges blend nursing criteria, curricula to close gap.

Byline: Greg Bolt The Register-Guard

A consortium of Oregon colleges is rewriting the prescription for getting a nursing degree in hopes of making the path to one of the state's most in-demand professions a little less painful.

The Oregon Consortium for Nursing Education effort is part of the state's response to what is expected to be a critical shortage of nurses in the coming decade as large numbers of them reach retirement age. The program won't immediately address the state's most pressing need - doubling enrollment in nursing programs - but it is expected to make it easier for students to apply as well as modernize the curriculum.

The program creates a common set of admission standards and prerequisite courses as well as a standard nursing curriculum for all of the schools signed up for the OCNE effort. Eight community colleges, including Lane Community College, and four Oregon Health & Science University nursing schools are taking part in the program. Pre-nursing students at LCC will come under the new standards this fall, and the changes will be applied to the nursing program in fall 2007.

Julia Munkvold, director of the LCC nursing program, said the new approach makes it easier on students who want to pursue a nursing career. It eliminates what has been a "go-it-alone" approach among colleges that left prospective students facing a welter of admissions standards, course requirements and financial aid rules that effectively prevented them from applying at more than one school.

"Before this, every single nursing program in the state of Oregon had different pre-requisites, so a student who wanted to apply here and at Linn-Benton (Community College) had to take a whole different set of pre-requisites even to apply. That's crazy," Munkvold said. "This (change) is a huge benefit to students."

The program also for the first time unites the two-year community college nursing programs with the four-year program offered at OHSU's Portland campus and three satellite campuses. Now students who complete a two-year nursing program at a consortium school have automatic admission into OHSU's bachelor's degree program.

It is believed to be the first time a state has tried to create a uniform nursing program across different schools and campuses. Louise Shores, project director of the consortium, said the aim is twofold: to increase efficiency to ease pressure on existing nursing faculty and clinical experience providers and to bring the curriculum up to date with modern nursing demands.

She said the days are past when most nurses worked in hospitals and cared for patients until they are well enough to go home. Nurses now work in a variety of settings, spend more time on wellness and disease prevention and care for patients who often are sicker and still need care after discharge.

"We went back to the drawing board and said what do we think people's needs are going to be in 2010," she said. "We know we'll have an older population so how will that effect what the nurse needs to be able to do."

What came out is a curriculum that doesn't try to be as broad and that teaches nurses how to deal with emerging needs and keep up with rapidly changing medical technology. Because nurses will be in short supply and providers will depend more on aides and other workers for more tasks, it also teaches nurses how to better delegate.

"We can no longer cover all the content that a nurse might need in the two years of an associate's degree program or the four years of a baccalaureate program," Shores said. "So one of the focuses of the new curriculum is on deeper understanding of 80 percent of the problems they will encounter rather than superficial coverage of 100 percent of the problems they will encounter."

The effort also tries to address two persistent problems in nursing education, a lack of enough nursing faculty and places for nursing students to get training. By establishing a uniform curriculum, the program eases the burden on faculty to develop and update courses and could free them to spend more time with students.

The curriculum also puts more emphasis on simulation to prepare students for clinical experience. In the past students went straight from the classroom into supervised experience in hospitals and other settings, but with a statewide shortage of clinical opportunities, simulation is becoming an important part of nursing education.

LCC recently purchased two simulation mannequins that emulate a variety of patient conditions through a computer interface and lifelike responses. Because short-staffed hospitals and clinics have less time to devote to nursing students, simulators allow them to go into clinical experience better prepared.

"We're building patient care scenarios for high-fidelity simulation experience, very similar to the way airline pilots learn how to fly planes," Shores said. "So they'll be much more skilled by the time they get into clinical facilities and that will take some of the pressure off clinical facility."

Munkvold said the changes are driven in part by the looming critical shortage of nurses; by 2010 it's expected that the demand for nurses will top the supply by 22 percent, a figure that could double by 2020. Almost half of the state's nurses are over 50 and retirement will create a critical shortage in the near future, studies show.

But it's also an opportunity to refocus nursing education to reflect the greater role nurses play in nonhospital settings.

"The focus is changing nursing education to look at the changing needs of nursing in society," she said. "The way health care economics are going, nurses are being utilized in a different way. More and more nurses are not working in hospitals; they're working more in wellness programs and community-based clinics, so we're going to try to increase that kind of education."

The new program won't add any new enrollment capacity in Oregon, where competition for the available openings in nursing programs is fierce and many qualified applicants are unable to get in. But Shores said the improved efficiency may help preserve some of the expansion that's already taken place thanks to funding from hospitals, the health care industry and private foundations.

And the innovative program could attract what's needed most: money. Shores said the National Council of State Boards of Nursing, the national accrediting body, is interested in the effort and has visited Oregon to learn more, and the OCNE program also is catching the eye of private foundations that could provide money to expand nursing education.

"There are a lot of endowment people who are highly interested in this, and if we can show this is a model for a statewide education pool then we're hoping to pull in outside funds," Munkvold said. "Since Oregon is not funding its own education systems anymore, we're trying to look toward who we can get funding from."