The Nursing Education Exchange (NEXus) was initiated in response to a national shortage of well-qualified nurse educators and a need to build a cadre of doctoral faculty across the western United States (American Association of Colleges of Nursing [AACN], 2011; Berlin & Sechrist, 2002). The need for faculty to be well prepared for 21st-century nursing education gave further emphasis to this initiative. A regional meeting of the Western Institute of Nursing (WIN) in February 2005 provided the setting for representatives from five collegiate distance-accessible doctoral nursing programs to meet and discuss how to develop a collaborative exchange that would be responsive to the national shortage in doctoral education. The goal proposed for NEXus was “to address the nursing shortage by educating well-prepared nurse educators through application of distance-accessible delivery methods” (NEXus, 2011a, ¶ 3). A further vision, consistent with the Western geography and environment, was to “enable rural nurses to remain in their home communities and be employed in rural nursing education programs while enrolled in doctoral studies” (NEXus, 2011a, ¶ 3). In addition, smaller or newly established doctoral programs would be able to offer a wider variety of elective coursework without recruiting and hiring additional faculty. This article describes the initiation and implementation of this successful nursing education collaborative, NEXus.
The creative collaborative approach of NEXus was conceptualized as a way to strengthen resources and provide support for PhD programs in the West while addressing the shortage of PhD-prepared nurses in higher education. The proposed nursing education exchange was viewed as a unique opportunity for collaboration among PhD nursing programs. Initially, the founding members believed such a collaboration was a timely response to a critical need. These founding institutions moved quickly to submit a grant application with the potential to share resources, faculty, and research and serve as a forum for exchange of knowledge about nursing and health.
NEXus began as a consortium of distance-accessible programs initially supported from the Fund for the Improvement of Postsecondary Education (FIPSE). The first courses were offered in the fall of 2006. This consortium was unique in that it offered shared courses in doctoral education, rather than shared degrees. Although similar to several well-established consortia in Florida (Long, 2007), Oregon (Tanner, Gubrud-Howe, & Shores, 2008), New Jersey (Quinless & Levin, 1998), Louisiana (Lund, Tate, & Hyde-Robertson, 1998), the Great Plains Interactive Distance Education Alliance (IDEA; Selkirk, 2011; South Dakota State University, n.d.) in the Midwest, and the Western Interstate Commission on Higher Education Internet Course Exchange (2013), NEXus developed a unique approach for students to gain access to high-quality doctoral education through collaboration and distance delivery.
In 2008, shortly after NEXus was established, the Robert Wood Johnson Foundation and the Institute of Medicine (IOM) launched a 2-year major initiative to assess and make recommendations that would transform the nursing profession in light of changing health trends globally, as well as nationally. The combined Robert Wood Johnson Foundation/IOM report was intended to provide an “action-oriented blueprint for the future of nursing” (IOM, 2010a, p. 1). Evolving from this report were observations that among the challenges in health care reform was a clear mandate for change in the nursing education system and solutions that must be implemented to advance this change. The need for nurses to “attain higher levels of education and training through an improved education system that promotes seamless academic progression” was paramount among the recommendations (IOM, 2010b, p. 1). One of the major recommendations of the IOM’s report was to double the national number of PhD-prepared nurses by 2020 (IOM, 2010b). The NEXus initiative was consistent with these recommendations.
A previous report of the Florida effort (Long, 2007) emphasized the challenges that schools encounter in developing PhD programs in nursing, especially from cost and resource perspectives. Long (2007) described somewhat limited success with the Florida consortium. The increase in graduates was modest. In addition, the AACN annual reports on doctoral enrollments suggest that growth in the number of doctoral programs has not produced the number of PhD graduates needed. Coupled with the disappointing growth rate of new PhD graduates is the increasing age and anticipated retirement of senior faculty qualified to mentor students (AACN, 2011; Tracy & Fang, 2010). The combination of recruiting qualified faculty and qualified students and procuring research funding while building the infrastructure to support scholarly work demands a new approach to sharing precious resources, which is a relevant approach taken by NEXus.
The call for a new approach to shared resources resulted in the development of an innovative interinstitutional set of agreements for sharing resources by the NEXus team. These agreements made graduate courses available through distance technology as a way of expanding efforts to strengthen faculty and educational initiatives among institutions. WIN was designated as the lead organization for the consortium, as outlined in the FIPSE-supported project. WIN is one of the first regional nursing research organizations, serving 12 Western states with a strong history of support for collaborative work.
Universities were selected from applicants who responded to a request from WIN to recruit members. With the assistance of consultants from the Great Plains IDEA consortium ( http://www.gpidea.org/) mentioned earlier, an initial planning retreat was held March 6–8, 2006, in Boulder, Colorado. At this meeting, the teams from each of the five participating schools or colleges of nursing, along with key administrators such as registrar, financial officer, graduate and nursing deans, bursars, and financial aid officers, participated in 2 days of orientation, examination of trends and documents, and team building. Again, with the support of the Great Plains IDEA consultants and with the benefit of publicly accessible documents developed by that consortium, the NEXus schools began the work of establishing the foundation for the collaborative. The NEXus executive board was formed, bylaws were written, memoranda of agreements were signed (in 2006), and procedures and policies were developed.
From its beginning days, the NEXus collaborative has grown and expanded beyond the original Western states to become a premier national consortium. Schools have full or affiliate membership, and Doctor of Nursing Practice (DNP) programs and courses have been added to the original PhD courses in the exchange ( http://www.winnexus.org). With a national voice, several positive external evaluations, and a plan for sustainability, as well as the continuing dedicated leadership of the Executive Director of WIN and Project Director for NEXus, the consortium continues to seek additional universities to enrich the academic programs of students in member schools.
Nexus: Promoting Collaborative Learning
NEXus now provides innovative collaboration for PhD and DNP program education among 12 participating universities across the United States (Table). Through NEXus, PhD and DNP students can matriculate at their local university but take distance-accessible courses offered by any member of the consortium regardless of where they live and work. NEXus gives students access to more than 150 courses for which they pay one common rate, inclusive of tuition and fees, as well as preferential admission to the courses of their choice. Of the common tuition price, a portion (10%) of the funds generated return to the home institution of the student; 75% goes to the teaching institution, and 15% provides assistance to the ongoing administration of the project.
Table: Nursing Education Exchange (NEXus) Academic Collaborator and Affiliate Collaborator Institutions
NEXus benefits its member nursing schools by providing complementary curricular strengths for distance education so each school can maintain strong doctoral programs, despite decreased budgets, reduced course offerings, and unfilled faculty positions. On an individual level, many nurses who are potential doctoral students cannot afford to leave jobs and family to relocate for doctoral education, and thus do not pursue doctoral studies. Distance education offers a viable alternative for these students.
Faculty teach the courses that have a close fit with their research interests and expertise. Unfilled course seats may be filled by students from member institutions, ensuring full enrollments. The enjoyment of teaching these courses to a wider audience is conducive to faculty satisfaction and retention. NEXus has strong administrative staff support, making it user friendly for students and participating institutions. The common core pricing is within a reasonable range, which makes it accessible to doctoral students and cost effective for the participating institutions. Filling otherwise empty seats brings the institution some unanticipated revenue that further supports the doctoral education programs.
The advantages to doctoral students who participate in NEXus courses are many. Students have the opportunity to study with leaders in nursing education, practice, and research, drawing on the individual strengths of the partner institutions. Off-time students can enroll in NEXus courses with the approval of their advisor and do not have to wait for those courses to appear in the course sequences of their home university. Potential dissertation or capstone committee members may be found among the teaching faculty, and students may be exposed to many more course offerings than are available at their home school. The enrollment process is facilitated for students in NEXus schools, and with their advisors’ approval, students can take a variety of courses pertinent to their degree and career plans. The number of credits a student can take is governed by the individual school’s policy and varies according to the institution in which the student is enrolled. Exposure to multiple platforms for distance education and nursing education electives available in the NEXus catalogue helps these future nurse educators to expand their repertoire of teaching skills.
Administrative Challenges of Partner Institutions
Building a consortium such as NEXus was not without challenges. Partner institutions must work through the “administrative maze,” which involves a series of steps that begin with a viable proposal or plan for implementation. After that plan is developed, approval begins with the dean or administrative head of a unit, doctoral program leaders, and university administration as well as support from the university’s infrastructure, including the registrar, general counsel, graduate school or college representative, financial aid officer, and technological support staff. When these key individuals are committed to supporting the structure, key faculty and administrators within the programs must be committed to providing the courses and recruiting students. This part of the process requires assurance that the quality of instruction in partner institutions will meet quality standards of sound pedagogy and of student accessibility to courses.
Clear memoranda of agreements that are comprehensive and written in a way that leads to mutual trust and commitment of participating institutions is critical. Elements of this understanding specify accessibility and pricing of courses, clarity in admission and graduation standards, quality of faculty, and quality of faculty credentials. The combination of best practices influencing curriculum, instruction, and technology that supports quality course delivery, faculty expertise, and quality students is based on the principles of inclusiveness, beneficence, collegiality, courage, perseverance, healthy conflict, shared leadership, and, above all, trust, as outlined by Tanner et al. (2008).
Nexus Best Practice Exemplars
Faculty associated with the NEXus collaborative are establishing best practices that facilitate the work of the consortium and make it user friendly. This includes positive collaboration among the member universities; the success of NEXus has depended on this positive collaboration. Collaboration is the basis for bringing together the knowledge, experience, and skills of multiple-team members to contribute to the development of a new product more effectively than individual team members by performing their own narrow tasks (Crow, 2002; Dicenso, 2008; Yeaworth, 1996). The phrase “bringing together” is an essential ingredient for NEXus growth.
Collaboration requires effective team work. Team members must trust and respect each other, have open communication, and be willing to accept the ideas of others. The biggest threat to successful collaboration may be competition. Had the group members used NEXus to promote themselves, the consortium would likely have failed. The potential for self-promotion was recognized at the outset and was avoided by establishing a set of guiding principles signed by officials of each member university. The first of the guiding principles directly addresses mutual respect: “The participating Doctoral programs mutually respect the academic standards and quality of the accredited universities involved in this collaboration” (NEXus, 2006).
In the attempt to create a student-friendly environment, a best practice was developed to guide the integration of NEXus students into the courses of a partner university. This best practice includes guidelines to help make the NEXus student feel welcome and a part of the group. Knowing that cohorts tend to become bonded, the faculty in the host, or home, school may need to take the lead in blending another student into the class. In an online format, posting photos allows the students to see each other, and small-group activities can be managed with sensitivity to group dynamics. Pairing the NEXus student with a student from the home school for assistance with platform applications helps him or her integrate faster.
One faculty member was asked how she would describe NEXus collaboration in her course. Her description attested to the benefit of collaborative learning: The students work on projects and presentations that result in an infusion of different frameworks and points of view that enhance the experience of each student.
A second best practice identified was the development of an institutional team to support NEXus. Based on the original gathering of institutional team members during the initial NEXus planning retreat, the University of Colorado formalized its own NEXus institutional team early in the project. It consisted of the NEXus faculty coordinator–partner representative, NEXus staff coordinator, nursing dean, university registrar, financial aid officer, finance officer, bursar, and graduate school dean. This team meets once or twice per year to evaluate how NEXus is working for its institution and to identify issues or problems. This practice spread to the other member institutions and made problem solving a team activity to provide solutions that are quickly and successfully identified. For example, when a fee was inadvertently charged to an incoming NEXus student, the team located the source of the fee assignment and the coding difficulty was corrected before additional NEXus students were enrolled.
The collaborative approach supported by NEXus increases collaboration among universities, faculty members, and students and leads to networking that goes beyond the end of the course. The NEXus members have determined that the collaborative is a win-win for all.
The Future of Nexus
Plans for the NEXus collaborative consist of three priorities at this time. Priority 1 is focused on the economic sustainability for NEXus. Three major efforts are in process to address this priority. First, a cost-recovery system has been developed to support NEXus beyond the current Health Resources Service Administration grant, which allowed continuation of NEXus, as FIPSE initially funded the project. Although membership dues have been in place since the funding transition from FIPSE to the Health Resources Service Administration, the board, with the agreement of the deans, recently voted to raise the dues in an effort to contribute to the financial sustainability of the collaborative. Second, expansion of NEXus beyond the 11 partner institutions is in process. For example, presentations have been made to the AACN semiannual meetings of deans and the AACN doctoral conferences to promote the collaborative and to increase the visibility of NEXus. A DVD (NEXus, 2011b) was developed (accessible through the Web site) and distributed to interested schools. Third, the NEXus staff and a sustainability subcommittee of the board are working actively to identify and seek further funding.
Priority 2 is focused on increasing the course offerings in the NEXus portfolio. Integration of DNP programs was initiated in the fourth year of the collaborative, and growth in this sector has been steady, especially as new DNP programs open across the United States. Universities may include either a PhD or a DNP program in the collaborative or both if the institution offers both programs. The fee is additional if two programs are enrolled. The collaborative has also experienced an increase in the overall number of courses that are available; for example, some schools are now allowing core courses to be a part of NEXus, a benefit to students who are out of sequence in their program of study. Further, members are making efforts to identify and market the content that may be available at participating or member schools and offer those to the NEXus consortium.
Priority 3 is focused on the expansion of the number of clusters, or groups, of courses that share similar content on a similar subject, identified by a keyword concept. A student might use that keyword to identify a group or cluster of courses that could be used to support a major or minor in his or her doctoral studies.
The NEXus consortium exists to promote learning in collaboration by facilitating doctoral students from different universities to share courses and experiences on which to build their future research, practice, and educational goals. Despite initial growing pains, the continuing expansion of NEXus is in itself a strong testimony to the success of the consortium. Since its inception, the model of collaboration, successful sharing of courses, and development of faculty networks around research and teaching interests have strengthened the relationships among the participating institutions. The project serves as a stimulus to participating faculty to develop more innovative course delivery, as well as to encourage collaborative learning among students. The future of NEXus is bright. This innovative delivery of content to doctoral students strengthens their education and the capacity of their universities to provide needed resources.
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Nursing Education Exchange (NEXus) Academic Collaborator and Affiliate Collaborator Institutionsa
|Academic Collaborator Member Institutions||Academic Affiliate Member Institutions|
|Arizona State University||Washington State University|
|Loma Linda University|
|Oregon Health & Science University|
|University at Buffalo|
|University of Colorado|
|University of Kansas|
|University of Nevada Las Vegas|
|University of New Mexico|
|University of Northern Colorado|
|University of Oklahoma|
|University of Texas at Tyler|
|University of Utah|