As a major contributor to transforming our health care system and improving our nation’s health, nursing is being challenged to significantly increase the educational preparation of its workforce over the next decade. As early as 2004, visionary North Carolina health care leaders concerned about the impact of our changing demographics on health care delivery, recommended a change in the number of RNs educated at the baccalaureate (BSN) level as compared to those educated at the associate degree (ADN) level from a 40 BSN:60 ADN ratio to a 60 BSN:40 ADN ratio . More recently, the 2010 Institute of Medicine Future of Nursing: Leading Change, Advancing Health Report called for the nationwide proportion of BSN educated nurses to be 80% by 2020 . The North Carolina Future of Nursing Action Coalition has set the goal of achieving 80% of our RN workforce having BSN or higher degrees by 2025 .
Demand for an increase in the educational preparation of nurses is being driven by a number of forces including an older population with increased chronic and complex health conditions, wellness promotion, and needed improvement in quality and safety outcomes and cost containment across our fragmented health care delivery system. These improvements require nurses to utilize high levels of critical thinking, problem solving, and patient management skills at all levels of care, and there is growing evidence that patients in acute care settings benefit when nurses with higher degrees provide care [4, 5]. There is also an urgent need for academic progression to assure a sufficient pipeline for future faculty, administrators, and advanced practice nurses prepared at the master’s and doctoral degree levels.
In North Carolina, the two-year Associate Degree in Nursing (ADN) program is the prevailing level of pre-licensure nursing education with 55 community colleges and 4 private colleges offering the associate degree as compared to 20 pre-licensure BSN programs, 4 of which are in the initial phases of development. In 2012, the ADN programs educated 58.5% of the state's new RN graduates while BSN and entry-level master’s programs (MSN) educated 37.2% and diploma programs educated 4.3% of these new RNs . Thus, our challenge is to increase the academic progression of nurses initially licensed at the associate degree level.
Even with 21 RN to BSN programs in the state and multiple out-of-state online opportunities for ADN nurses to achieve a BSN, North Carolina continues to have insufficient numbers of ADN graduates continuing their education. In 2011, 54.6% of the total 95,335 RNs working in North Carolina held an ADN as their initial degree for licensure. Of these, 16.7% had achieved higher nursing degrees (12.5% BSN, 4.1% MSN, and 0.1% nursing doctorate) while 64.6% continued to hold an ADN as their highest degree . Historically, the majority of associate degree nurses who do pursue BSN or higher education have done so well into their careers, which limits the long-term impact of their educational progression.
If our nursing workforce is to effectively participate in the transformation of health care and build the necessary pipeline for future nursing faculty and advanced practice nurses, it is imperative that North Carolina create new pathways for qualified nursing students entering associate degree programs to seamlessly progress to the completion of a baccalaureate degree at the beginning of their careers.
A component of a multi-regional project funded in part by the Robert Wood Johnson Foundation, Northwest Health Foundation, Jonas Center for Nursing Excellence, UNC General Administration and The Duke Endowment
In 2008, Asheville Buncombe Technical Community College (AB Tech), Western Carolina University (WCU) and the Foundation for Nursing Excellence (FNE) began the RIBN journey. With advice from a national team of experts, sharing strategies for curriculum and faculty development as well as evaluation tools with partners in metropolitan NYC, the WNC RIBN team adapted the Oregon Consortium for Nursing Education (OCNE) model for dually admitting qualified students into a seamless four-year educational tract. The first cohort of students began the WNC RIBN educational track Fall Semester 2010 with the goal of achieving their BSN degree in 2014.
The Foundation for Nursing excellence is supporting the continued expansion of the RIBN model across North Carolina.
Carolina Central - Central Carolina Community College and North Carolina Central University
Centralina - UNC Charlotte, Gaston College, Central Piedmont Community College, and Carolinas College of Health Sciences
Eastern North Carolina - East Carolina University, Lenoir Community College, Beaufort County Community College, Craven Community College, Roanoke-Chowan Community College, and Pitt Community College
Hickory - Lenoir-Rhyne University, Caldwell Community College and Technical Institute, Catawba Valley Community College, Western Piedmont Community College, Wilkes Community College and Mitchell Community College
North Carolina Piedmont – NC A&T, Davidson County CC, Guilford Technical CC, Vance-Granville CC
South Central - UNC Pembroke, Robeson Community College, Richmond Community College, Sandhills Community College, Southeastern Community College
Triangle-Triad - Winston Salem State University, Durham Tech Community College, Wake Tech Community College, Forsyth Tech Community College, Randolph Community College
Western North Carolina - Western Carolina University, Asheville-Buncombe Technical Community College, Southwestern Community College, Isothermal Community College, and Blue Ridge Community College
Wilmington - UNC Wilmington and Cape Fear Community College