Nursing Schools Roll Out New Programs

New trends in healthcare and staff shortages trigger changes in nursing education.

By Ann R. Brice, Contributing Writer On Sep 26, 2016

New Jersey’s several dozen nursing schools have educated untold numbers of nurses over the past decade, and, additionally, a significant number of RNs, LPNs and APNs are in the pipeline. Aspiring nurses in large numbers are being drawn to the profession – the largest in the healthcare field – for various reasons, not the least of which are economic.

They may well be needed for new positions and replacing nurses in today’s 125,000-strong workforce who are planning to retire in the next 5 to 10 years. Many baby boomers who postponed retirement during the last recession might now be ready, say experts, who note that the average age of New Jersey nurses is 51; that of nurse educators is even higher.

While one recent federal government report showed a surplus of 20,000 nurses in New Jersey, it failed to forecast future needs. “I would be cautious about saying there’s a surplus of nurses in New Jersey,” says Edna Cadmus, PhD, RN, executive director of the New Jersey Collaborating Center for Nursing (NJCCN) at Rutgers, created by the State Legislature in 2002.

“When you think about more nursing roles being developed outside of hospital settings, any current surplus may be eaten up quickly,” she adds. Baby Boomers are aging, seniors are living longer, and the 2010 Affordable Care Act (ACA) is expanding health coverage.

Nursing school deans and others disagree on whether a nursing shortage exists, but most say it does. As a whole, the deans agree that the aging population and moves towards the health population concept in the community will heighten the demand for nurses going forward.

“Nursing will be moving from structured environments like hospitals to areas like long-term care and home care,” says Cadmus, noting that is where future opportunities for nurses will be. “The goal is to try to help people remain in their homes and not be re-hospitalized.”

Today, while some 48 percent of New Jersey’s nurses work in hospitals, the remainder serves patient needs in long-term nursing, assisted living, rehab centers, community health agencies, clinics, schools, etc.

Nursing Schools Respond

Shortages in nurse educators have also been a concern, although efforts to expand doctoral and master’s programs may have already helped. “From what we’ve seen, an adequate number of seats are available for people to go into nursing,” Cadmus comments. “We’re not at a point where we can’t get people into programs.”

Studies have repeatedly shown that patients experience better clinical outcomes when nurses have baccalaureate degrees. A frequently cited 2010 Institute for Medicine Report on the future of nursing set as a goal that 80 percent of nurses become BSN-prepared by 2020.

“That benchmark still stands,” Cadmus notes, although only 52.3 percent of New Jersey’s registered nurses (RNs) have bachelors of science in nursing.

In response, schools are encouraging associates degree graduates to get their BSN in a variety of ways, and they are adding new curricula and resident programs.

Rutgers School of Nursing

Rutgers will roll out a first of its kind residency program for new BSNs to work in out-of-hospital settings as a result of a $4.7-million grant, with the first group of nurses to begin in fall of 2017. The residency sites will be in nursing homes, home and continuing care, and community health settings as the focus shifts away from hospitals

“Out-of-hospital settings are more demanding,” says William Holzemer, PhD, dean, adding that mentors will coach the new nurses during their final years of schooling as well as in career centers once on the job. Holzemer says the effort is part of a model that others might emulate in adjusting undergraduate curricula to workforce demands.

Rutgers School of Nursing confers nursing degrees in numerous BSN and graduate level programs. It is closely allied with the Rutgers medicine, dentistry, pharmacy and other health career schools with campuses in Newark, New Brunswick and Blackwood. Its average enrollment is 1,700 students.

A previous grant from the Robert Wood Johnson Foundation helped forge the New Jersey Nursing Initiative (NJNI), notes Susan W. Salmond, EdD, Rutgers’ executive vice dean, a former NJNI director. NJNI works with faculty to revamp nursing education to include more on community-based care and population health.

Towards this end, Rutgers has made recent changes in academic offerings, notes Salmond, including the adding of new graduate programs on population health and chronic care management as well as on care coordination, also offered to undergraduates.

Its nine doctor of nursing practice advance specialties include the only nurse anesthesia and nurse midwifery program in the state. The school has moved all APN programs for nurse practitioners to the DNP degree level “recognizing the growing complexity of the practice arena,” Salmond adds.

The majority of APNs are nurse practitioners (NPs). Today, all nurse practitioner students must take a course on the business of practice to gain more understanding of value-based care and reimbursement.

The 2017 rankings in U.S. News & World Report list Rutgers’ nursing graduate programs as among the top 20 in the nation.

Seton Hall School of Nursing

Seton Hall and Hackensack-Meridian have unveiled plans for a new medical school co-venture that will enter its first class in fall of 2018 in Clifton at the former site of the Hoffmann-LaRoche R&D and manufacturing facility. It will be known as the Seton Hall-Hackensack-Meridian School of Medicine.

Seton Hall’s entire school of health and medical science, including its College of Nursing, will be housed on that campus, bringing together occupational and physical therapy, medical sciences, nursing, physician’s assistants and related fields and offering opportunities for greater team-based approaches to medicine.

At its South Orange location, Seton Hall’s College of Nursing offers bachelor’s-degree-level programs and higher, with 550 undergraduate and 300 graduate nursing students currently enrolled.

“Students come to Seton Hall because there’s a sense of humanistic care and a lot of service leadership,” says Marie Foley, PhD, dean of the College of Nursing, noting the mission trips that its students take to overseas countries.

Curriculum innovations include three undergraduate programs to advance an established nursing career, both on campus and online as well as a bridge program for non-nursing college graduates.

A newly established clinical nurse leader program enables students with a degree in another major to go for two full years and graduate with a master’s in nursing. “The VA hospitals utilize clinical nurse leaders a lot,” Foley notes, “and many of our students get jobs there.”

In the fall of 2016, some 17 percent of freshmen will be male, notes Foley, in line with recent moves on national and local fronts to recruit more men into the profession. The comparable national average is 8 percent for RNs; 11 percent for licensed practical nurses (LPNs) and 10 percent for advanced practice nurses (APNs).

“Truly, at least 80 percent of our graduates secure jobs within six months and nearly 100 percent find jobs after the first year, mostly in hospitals,” Foley says.

Ramapo College

Ramapo College’s nursing program in Mahwah has recently developed an MSN track to prepare future nurse educators. It also has an RN to BSN program for nurses returning to school and looking to make a change as well as a baccalaureate nursing program for traditional students.

“Things in healthcare have changed dramatically over the past 10 years,” comments Kathleen Burke, PhD, assistant dean in charge of nursing. While the ACA influenced the current environment, the call was begun with the Institute of Medicine report on the future of nursing.

One recommendation was that nurses need to be allowed to practice at the maximum of their credential and ability, Burke notes. “A lot of nurses are not allowed to work to their full capability. They need to be full partners with physicians and others in redefining healthcare.”

Some 15 percent of Ramapo’s 600 nursing students are male, a higher-than-average ratio, and “the ethnicity reflects the diversity of the environment.” A group of its students recently volunteered for a community effort involving wellness programs with Ramapough nation residents in Ringwood, which turned out to be a big success.

Burke compared today’s college nursing programs with former hospital-based ones, which required from two to three years of training, noting that they are becoming “a rare breed” because of the push towards the baccalaureate.

Trinitas Regional Medical Center

Trinitas’ School of Nursing in Elizabeth and others run counter to that trend. It has a cooperative program with Union County College (UCC) granting a diploma in nursing and an associate in science degree. The general education in science comes from UCC, while “the nursing curriculum continues in conjunction with our mission and philosophy,” says Donna Penn, MSN, school of nursing dean.

Currently, Trinitas has 579 students taking nursing courses, and nearly 2,000 who have declared nursing as their intended major at UCC, although not everyone will be accepted. Most are evening students who tend to be second career individuals in their mid-20s and early 30s, Penn notes.

“Jobs in healthcare are very hot right now,” Penn adds, “so more people are thinking of moving into the field. It’s a top occupation in terms of growth, and that’s expected to increase over the next several years.”

What makes Trinitas’ program unique, she comments, is that it offers day, evening and weekend programs, which give students flexibility as to when they attend school and do the clinical component. “We have the ability to take in a large number of students,” Penn adds.

Trinitas offers tuition reimbursement for nurses opting to go for advanced degrees, which is consistent with most hospitals, although the extent of the benefit varies. Its graduates receive an annual starting salary of $65,000 to $70,000.

CarePoint Health System and Hudson CCC

As with Trinitas, CarePoint’s School of Nursing in Jersey City grants a diploma in nursing, although it is “transitioning” to make its partner, Hudson County Community College (HCCC), the sole “owner” of the associate level nursing program.

CarePoint hospitals will continue to be used for clinical work, and “the program will essentially remain the same,” notes Catherine Sirangelo-Elbadawy, associate dean of HCCC’s Nursing & Health Sciences.

HCCC’s program has “a nice mix of students” with the average age at 29 to 30. Sirangelo-Elbadawy recalls the time she asked one second career student why he was moving from an insurance company to nursing. “He said it wasn’t fulfilling and that he ‘wanted something that made a difference.’”

Sirangelo-Elbadawy says HCCC has a “very active” advisory board with all different disciplines represented, e.g., hospitals, community health, doctor’s offices, and any other area in which a nurse would practice. A board member is assigned to communicate with the school about changing trends.

Regarding education trends, she believes the biggest one is not at the associate’s level; it is the BSN program for people who already have a college degree in some other field, enabling them to finish in 15 to 18 months. About one-half of HCCC’s associates degree graduates go directly on for a BSN.

AtlantiCare Regional Medical Center

While AtlantiCare has no nursing school, it partners as a site for clinical rotations with Atlantic Cape Community College; Stockton University; and Rutgers University Camden School of Nursing. It had 273 undergraduate and 22 graduate students in the spring semester.

AtlantiCare has two hospital locations, i.e., the main one in Pomona and the other in Atlantic City. Robyn Begley, DNP, AtlantiCare’s vice president and chief nursing officer, points to the hospital’s community service record in helping casino workers who were unemployed due to closures.

“Partnering with Atlantic Cape CC, we helped provide them with training in in-demand healthcare fields such as EKG/monitor technician, certified home health aide and patient care technician,” Begley notes. “We have also seen more former casino employees consider a career in nursing.”

In training nurses, “our health system takes a team approach to patient care,” Begley says. They get to work with staff nurses, physicians, pharmacists, technicians, patient care associates and others who provide patient care.

AtlantiCare offers continuing education courses and conferences for nurses and other healthcare professionals and provides tuition reimbursement for formal academic pursuits. In hiring new graduates, it looks for them to hold BSN degrees.

Thomas Edison State University

Thomas Edison’s W. Cary Edwards School of Nursing in Trenton is a blend of online interactive classes in the medical sciences with face-to-face clinical work taking place on campus. “We were the first online nursing program in New Jersey,” says Filomela Marshall, EdD, dean of the nursing school.

Because of its appeal to self-directed adults, its programs focus on working nurses or those with a degree in something else who decide to become a nurse. The latter enroll in an accelerated second degree BSN program while already registered nurses enter RN to BSN or RN to MSN programs, which are the largest.

A $125,000 grant from Investors Bank Foundation will allow Edison to further integrate simulated clinical scenarios into online students’ curricula as another learning tool. It will also be used for an existing on-ground nursing simulation lab used in the accelerated second degree BSN program.

Simulators have machines or mannequins that look like human beings. They can be made to have a seizure, for example, or develop symptoms such as blue lips, a fever or high blood pressure. Students go through the scenario of how they would respond clinically to the incident, but in a risk-free environment.

In the fall of 2016, the school will launch its first doctoral program, i.e., a doctor of nursing practice with specialization in health system leadership.

Berkeley College

Berkeley College’s School of Health Studies is unique in that it educates LPNs and patient care technicians, not RNs. However, that soon will change. Both programs are offered at its Dover and Woodland Park campuses; the LPN program is also offered in Newark and Middlesex.

In fall, 2016, Berkeley will launch a program to help LPNs become baccalaureate-prepared nurses. Some 20 students will comprise the inaugural class. “We’re keeping it small and intimate” in the first year, says Josiane Hickson, EdD, chair of the nursing and patient care technician program. “If students need support, we want to be there to help them succeed.”

New Jersey salaries average about $50,000 for an LPN and $46,000 for a healthcare technician as compared with $90,000 for an RN, Hickson notes.

Upon completion, LPNs must take a national licensure examination. When passed, they usually get jobs in nursing homes, clinics, long-term care facilities, ambulatory and same day surgery centers.

Hickson believes that the full effects of the ACA are yet to come when it comes to nursing.

The More Things Change

Some might argue that the more things change, the more they stay the same. Looking beyond the ACA and the latest changes in the system, one dean emphasizes the more traditional aspects of nursing that – in her mind – continue to apply.

“Healthcare has become a big business,” HCCC’s Sirangelo-Elbadaway concludes. “People come into nursing for all different reasons. If entering the field for salary and security, it won’t sustain them through a career. There’s not the commitment that should be there when you’re doing something for humanity. It should be in your heart to do it.”