Journal of Nursing Education

Major Article 

Advancing Associate Degree in Nursing-to-Baccalaureate Degree in Nursing Academic Progression: The California Collaborative Model for Nursing Education

Liz Close, PhD, RN; Carolyn Orlowski, MSN, RN

Abstract

Background:

In 2004, nurse leaders in California recognized the imminent need to increase the number and educational preparation of the state's nursing workforce. The California Collaborative Model for Nursing Education (CCMNE), a key strategy to meet this goal, was introduced in 2008.

Method:

The CCMNE set a new statewide standard for associate degree in nursing (ADN)-to-baccalaureate degree in nursing (BSN) progression by defining seamless academic progression parameters. The CCMNE's five core components are dual enrollment, integrated curriculum, shared faculty, BSN within 1 year of ADN conferral, and permanence and sustainability. Flexibility in operationalizing the core components accelerated the development of effective approaches systematically shared across the state to support CCMNE development and implementation.

Results:

Nearly 7% of the current California ADN student population is dually enrolled in a BSN program through 19 university-based CCMNE partnerships with 59 community colleges.

Conclusion:

The CCMNE provides ADN students early access to BSN education, which is promising for increasing the percentage of baccalaureate-educated nurses in the workforce. [J Nurs Educ. 2015;54(12):683–688.]

Abstract

Background:

In 2004, nurse leaders in California recognized the imminent need to increase the number and educational preparation of the state's nursing workforce. The California Collaborative Model for Nursing Education (CCMNE), a key strategy to meet this goal, was introduced in 2008.

Method:

The CCMNE set a new statewide standard for associate degree in nursing (ADN)-to-baccalaureate degree in nursing (BSN) progression by defining seamless academic progression parameters. The CCMNE's five core components are dual enrollment, integrated curriculum, shared faculty, BSN within 1 year of ADN conferral, and permanence and sustainability. Flexibility in operationalizing the core components accelerated the development of effective approaches systematically shared across the state to support CCMNE development and implementation.

Results:

Nearly 7% of the current California ADN student population is dually enrolled in a BSN program through 19 university-based CCMNE partnerships with 59 community colleges.

Conclusion:

The CCMNE provides ADN students early access to BSN education, which is promising for increasing the percentage of baccalaureate-educated nurses in the workforce. [J Nurs Educ. 2015;54(12):683–688.]

Academic progression in nursing is a national strategic priority and is essential for California to meet evolving health care needs through a more highly educated nursing workforce. In 2004, nurse leaders in California embraced the challenge to increase the number and educational preparation of the state's nursing workforce in response to anticipated supply challenges and nursing role expansion. HealthImpact (formerly California Institute for Nursing & Health Care), the state's designated Nursing Workforce Center, served as the convener and catalyst for launching the statewide effort to build nursing educational capacity (Boller & Jones, 2008; Jones & Close, in press; Jones & Leach, 2005). In 2006, the Gordon and Betty Moore Foundation funded HealthImpact to engage California thought leaders representing key stakeholders in shared evidence-driven dialogue about the changes needed in nursing education. The result of these statewide efforts was a consensus-driven white paper on nursing education redesign (Boller & Jones, 2008). One of the key strategies, the California Collaborative Model for Nursing Education (CCMNE), introduced in 2008, supports a streamlined education pathway using a shared curriculum model (Close, 2012, 2013a, 2013b) for more nursing students to achieve a baccalaureate degree early in their careers (Jones & Close, in press). Details of the consensus-building process among California nurse leaders, the impact of state legislation and the IOM report (2010) on program development, operational definition flexibility and refinement of the CCMNE Core Components, and emerging impact with examples from across the state are forthcoming (Jones & Close, in press).

Considered the most effective approach for California to prepare the number of baccalaureate (BSN)-educated nurses needed in the state for the future, the CCMNE demonstration projects initiated in 2009 focused on education redesign by building on the large number of existing community college associate degree (ADN) programs in the state. Demonstration projects generously funded by the Kaiser Permanente/East Bay Community Foundation, the Foundation for California Community Colleges, and a variety of special state-funded grants leveraged resources to support program development (Jones & Close, in press). Accelerated by new state legislation in 2009 that required “articulated nursing degree pathways” (CA Assembly Bill 1295, 2009) and the Institute of Medicine's report on The Future of Nursing (2010), the CCMNE has been embraced by a substantial proportion of the state's public sector ADN and ADN-to-BSN programs (Jones & Close, in press). In-state private universities are also committed to the CCMNE in partnership with community colleges, helping to expand the limited public sector capacity for postlicensure BSN education.

The CCMNE framework has fostered a pathway for engaging and influencing regions and the state to move forward in building necessary infrastructure to increase ADN-to-BSN accessibility and BSN completion immediately following ADN graduation and licensure. Table 1 reflects the current level of public and private nursing program engagement in the CCMNE, with 28% of universities and 66% of community colleges involved. Approximately 7% of the currently enrolled ADN student population in California is dually enrolled in BSN coursework through 19 established CCMNE programs.

Academic Institutions in California With a California Collaborative Model for Nursing Education (CCMNE) Type of Associate Degree in Nursing (ADN)-to-Baccalaureate Degree in Nursing (BSN) Program

Table 1:

Academic Institutions in California With a California Collaborative Model for Nursing Education (CCMNE) Type of Associate Degree in Nursing (ADN)-to-Baccalaureate Degree in Nursing (BSN) Program

CCMNE Core Components

The CCMNE is purposefully designed to maximize operational flexibility and incorporate unique institutional characteristics while maintaining integrity of intent to adopt a set of specific characteristics known as the CCMNE Core Components. Table 2 summarizes the operational definition and rationale for each of the Core Components (California Institute for Nursing & Health Care, 2013). In crafting this model, California nurse leaders were able to acknowledge unique school-specific features, encourage collaboration between community college and university faculty and student support systems, and minimize or remove many existing institutional barriers to a seamless ADN-to-BSN curriculum path. Committing to this model meant that nursing programs could build upon existing curricula and established relationships, identify and creatively address impediments and, importantly, move quickly to begin increasing the proportion of ADN graduates who ultimately complete the BSN. Most of the state's ADN and BSN programs elected to form regional collaboratives based on the schools' geographical locations.

Operational Definitions and Rationale for California Collaborative Model for Nursing Education (CCMNE) Core Components

Table 2:

Operational Definitions and Rationale for California Collaborative Model for Nursing Education (CCMNE) Core Components

An example of a CCMNE program that meets the five Core Components is the partnership between Sonoma State University and five regional northern California community colleges, which was established in 2009 and titled the Collaborative Nursing Education Continuum Model (CNECM). The integrated curriculum was established through comprehensive review and adjustments to existing ADN and ADN-to-BSN curricula, with the elimination of duplicative content and validation of essential content for each of the ADN programs. University and community college nursing faculty routinely actively participate in each other's advisory councils, support curriculum review and revision, and teach across programs—all of which meets the intent of the shared faculty component. Dual admission is achieved by competitive admission to the BSN program and enrollment in BSN coursework during the summer between the first and second year of the ADN program. ADN-to-BSN students in the CNECM are able to complete the 24 units of required BSN coursework and 6 units of upper-division general education in one summer and two academic terms (total of 1 year) following their graduation from the ADN program. All CCMNE components are institutionalized at the partnering community colleges, including academic advising and program planning that ensures ADN-to-BSN students, at the time of admission, have completed all requirements for the BSN, except the upper-division nursing and general education courses. The financial sustainability is guaranteed by a combination of self-support and state General Fund resources. Further information on the CNECM is available at http://www.sonoma.edu/nursing/bsn-post/cnecm.html.

Operational Strategies Supporting Success

Remarkably, the CCMNE Core Components interact and influence each other in unanticipated ways. In 2013, CCMNE programs identified four key factors that support successful program development and implementation:

  • Designation of a program director.
  • Coordinated student advising.
  • Shared faculty.
  • Involvement of diverse constituencies to support sustainability.

Those key factors are directly associated with the Core Components and provide further insight into unique interdependent and interactive features of the CCMNE.

One salient lesson clearly emerging from successful CCMNE programs is the necessity of employing a dedicated program director to consistently address the myriad curriculum and operational challenges and proactively implement progression strategies to meet the intent of the five core components. This discovery supports a key finding from the Oregon Consortium for Nursing Education that program integrity and sustainability pivoted on this crucial role (Tanner et al., 2012). In fact, the first step recommended in developing a regional collaborative is to identify and employ a seasoned nursing education administrator to guide the planning and implementation efforts and coordinate the wide variety of university and community college faculty and staff that must be involved in curriculum integration and student support services, such as admissions and records, academic advising, and financial aid. The program director is also responsible for facilitating institutional permanence and financial sustainability of the model, engaging shared faculty in curriculum alignment and evaluation, and troubleshooting the coordination of community college and 4-year institution policies and procedures.

Coordinated and accurate academic advising of students early in their ADN program exemplified in this model is crucial and greatly influenced by a truly integrated curriculum (CCMNE Core Component). In addition to the nursing content, the academic program plan should clearly reflect every ADN and BSN degree requirement and how each is met. Community college and university nursing faculty, education counselors and academic advisors, and the registrar's office staff commit to a unified purpose in this academic progression model and leverage their considerable expertise and experience in achieving a seamless ADN-to-BSN path. Student academic advisement is then based on clear, published, coordinated degree requirements to support BSN completion in a reasonable time frame. In the CCMNE, that time frame is defined as within 1 year of ADN graduation, as described in Table 2.

Shared faculty is the terminology adopted for community college and university nursing faculty sharing values and strategies to promote ADN-to-BSN progression. It is evidenced by practical components such as teaching theory and clinical across programs, actively engaging in the governance of each other's nursing departments, participating in curriculum development and evaluation, and behaving as a faculty of the whole without having to be employed by the participating academic units, although some collaboratives cross-employ faculty. By adopting the latter component, faculty may form content-, specialty-, and interest-based groups within and across institutions with which they may share scholarly resources, learning activity strategies, and a mutual respect for the significant contributions of each to advancing the education of nurses.

The importance of involving a diverse constituency in efforts to streamline ADN-to-BSN academic progression cannot be overstated. In addition to the faculty and academic advising professionals already mentioned, the following have been engaged early on in the collaborative process: student financial aid staff, faculty in related and prerequisite disciplines, university and community college administrators, postlicensure BSN program alumni, current student representatives, and practice partners. For example, key financial aid professionals' collaboration is paramount to ensure student financial aid eligibility to the greatest extent possible while in all phases of ADN-to-BSN progression. With the common goal to guarantee a seamless, quality ADN-to-BSN academic progression, each of these contributors has unique perspectives and wisdom to share in crafting the program. The truly collaborative endeavor recognizes all key participants and validates their significant impact on the development, implementation, and evaluation of ADN-to-BSN programming.

Rapid Dissemination of Emerging Effective Practices

A major approach supporting statewide CCMNE adoption, expansion, and success involved the centralization of resources and shared planning, from which individual CCMNE programs obtained technical assistance, and the leveraging of colleagues' experiences across programs for optimum efficiency. As the California Nursing Workforce Center, HealthImpact provided the fulcrum upon which these functions have succeeded. Two specific types of technical assistance were instrumental in fostering rapid dissemination of emerging effective practices within the model's framework: planned face-to-face meetings and conference call gatherings.

Between 2009 and 2014, HealthImpact hosted regional and statewide CCMNE meetings for participants from collaboratives around the state to present strategies, challenges, and successes. HealthImpact staff facilitated refinement and evolution of the model's Core Components' operational definitions and highlighted curriculum and program delivery strategies with common features. Regional CCMNE programs presented information on their own CCMNE programs and were able to leverage each other's experiences to advance regional and statewide progress. Participants worked in small groups to assess challenges and solutions that had been discovered or needed further investigation. This coordinated approach to statewide planning, technical assistance, and implementation served as a continuous feedback loop that supported model improvement, while honing a variety of approaches to meeting the Core Components. The rationale and intent have been sustained and advanced through this process, with built-in flexibility that appeals to emerging programs, with CCMNE programs being encouraged to craft their programs according to regional specific parameters and needs.

Roundtable conference calls were also conducted to address requests for specific assistance and guidance with strategies related to each of the five Core Components. The format for each call was similar, addressing a focused area of interest and providing opportunities for formal presentation from participants around the state to share experiences and learning related to their CCMNE operations, followed by open, facilitated discussion to strengthen adoption and progress. This approach also provided a dynamic forum for academic institutions and faculty more experienced with the model to share success strategies supporting the development of newly emerging collaboratives and academic leaders new in their positions. For instance, the core component Permanence and Sustainability roundtable conference call involved presentations about approaches to program funding through state monies, self-support options, and various combinations of both. In this fashion, colleagues shared information and experience to inform and advance each other's unique program characteristics and implementation. Thus, the state rapidly moved forward together, while supporting unique program design and contributions of CCMNE partners. Individual ADN-to-BSN program features were considered related to the definition and intent of each of the Core Components, supporting program development and expansion, while ensuring the integrity of the CCMNE.

CCMNE Statewide Impact

Expansion and sustainability of CCMNE programs has been a strategic priority to achieve meaningful impact of increasing the percent of BSN-educated nurses in California. The 19 CCMNE programs, or collaboratives, currently operating in California (Table 1) reported an aggregate of 431 ADN students newly enrolled in 2015 in CCMNE programs leading to a BSN degree, which is 7% of the state's ADN students. Prior to 2009, no ADN students concurrently sought the BSN, and no ADN students sustained formal institutional relationships that promoted collaborative educational programming for ADN-to-BSN progression. At that time, CCMNE partnerships were just beginning as a direct result of the 2008 California white paper on nursing education (Boller & Jones, 2008; Jones & Close, in press).

One of the most remarkable transformations in California has been the dismantling of entrenched educational silos, where ADN and BSN programs competed for students, replaced through emerging academic partnerships with shared goals, building on ADN programs as the foundation for educational advancement to attain a BSN degree. To achieve the CCMNE Core Components, California community colleges and universities had to:

  • Closely examine and coordinate the ADN-to-BSN academic progression path by eliminating unnecessary and duplicative content (integrated curriculum, BSN attainable within 1 year of ADN conferral, and shared faculty).
  • Coordinate actual concurrent enrollment in separate educational systems (dual admission).
  • Make commitments and financial plans for long-term partnerships to promote access to postlicensure BSN programs for ADN students (permanence and sustainability).

This necessitated ADN and BSN nurse educators to work together and communicate in new ways to coordinate planning and to align guidance and support to students. The partnership of San Francisco State University and the City College of San Francisco is an example of such a process and discoveries during the attempt to align ADN and BSN curricula and ultimately coalescing as a collaborative (Landry et al., 2012).

California's nursing workforce of more than 400,000 RNs represents 14% of the entire RN workforce in the country. The number of new RNs completing a prelicensure nursing program annually increased by 83% in the past decade (Waneka, Bates, & Spetz, 2013). During that time, a steady increase in the annual number of BSN graduates tripled, and entry-level master's graduates quadrupled (Waneka & Spetz, 2014, p. 7). The number of licensed ADN-educated nurses in the workforce who completed a postlicensure BSN program in California also quadrupled in the same time frame, as indicated in Table 3 (Waneka & Spetz, 2014, p. 7). This remarkable progress is due in part to community college and university nursing faculty working together with a collaborative mission to promote a higher educated nursing workforce for the future. A significant cultural change has occurred, with commitments to CCMNE fostering partnerships heretofore unseen in the California nursing education community.

California Nursing Student Completions (Graduations), 2004–2014

Table 3:

California Nursing Student Completions (Graduations), 2004–2014

CCMNE programs are proving to be an effective strategy for ADN students to begin BSN coursework while in their ADN programs and complete the BSN degree within 1 year of ADN graduation. Greater numbers of ADN students obtaining a BSN degree at the start of their careers effectively minimizes barriers typically reported by nurses returning to school after they are in practice and later in their careers. Licensed nurses working in California who began practice with an ADN degree report an average of 10.5 years between receiving their ADN degree, deciding to return to school, and then completing a BSN degree (Spetz, Chu, Bash, Lin, & Keane, 2014, p. 34). More than two thirds (68.6%) of nurses who completed postlicensure education between 2008 and 2013 were part-time students, typically because of their need to balance personal, family, and financial obligations. These findings consistently reflect known obstacles to employed RNs returning to school, such as competing priorities with cross-generational family responsibilities, balancing personal and academic time, having sufficient financial resources, and the need to remain employed while meeting academic goals.

When CCMNE programs coordinate and support a planned academic pathway for ADN students to also obtain their BSN education through dual admission, students begin BSN courses while concurrently enrolled in their ADN programs. After completing their ADN degree, they continue to complete remaining BSN degree requirements within 1 calendar year of full-time study. This student population is typically younger, with fewer personal and family obligations and employment-related responsibilities, compared with nurses who return to school later in their careers.

The cost of obtaining a BSN degree through a CCMNE program is significantly less than through a traditional prelicensure BSN program because substantial nursing prerequisite general education and nursing coursework can be completed in the less expensive community college environment. CCMNE programs build on coursework completed through community colleges at lower cost with higher priced university enrollment focused on unique baccalaureate nursing content and upper division general education. In some cases, scholarships can also be used for academic expenses across both the ADN and ADN-to-BSN programs, with continued course enrollment resulting in a BSN degree.

CCMNE programs report lower student attrition rates for personal or academic reasons, influenced in part by the timing of student enrollment in BSN coursework, typically occurring after completion of the first year of ADN nursing coursework. Evidence of success in the first year of the ADN program is vital to acceptance into a CCMNE program and is an early indicator of academic success in nursing. Experience gained during the first year of the prelicensure ADN program also contributes to reaffirming nursing to be a career of choice, engaging highly motivated and career-oriented students to commit to completing their BSN degree through a CCMNE program.

Aligning the diversity of the California nursing workforce with that of the California population is a crucial statewide goal. For example, California's Hispanic nursing workforce is under-represented, compared with the population of the state; thus, a priority for growth exists in both the number and advancement of Hispanic nurses with higher levels of nursing education. California community college ADN programs enroll a greater proportion of Hispanic students (22%), compared with university prelicensure BSN programs (16%; Waneka & Spetz, 2014). Students enrolled in community colleges represent diverse ethnic and minority groups, including varied socioeconomic composition, which more closely reflects local communities. CCMNE programs draw applicants directly from community college ADN programs—an already diverse applicant pool—which can ultimately lead to a more diverse BSN-educated workforce.

Moving Forward

The CCMNE offers a streamlined education pathway through a shared curriculum model (Close, 2012, 2013a, 2013b) for more nursing students to achieve a BSN degree early in their careers as they begin practice. Provided by universities in partnership with community colleges, the model leverages resources across academic institutions to provide a greater number of BSN-educated nurses through a coordinated curriculum and seamless academic plan that builds on ADN programs as the foundation of prelicensure education. Recruitment of students directly from community colleges representing diverse communities supports the development of a higher educated nursing workforce that closely reflects the ethnic and socioeconomic composition of the communities served.

CCMNE program expansion increases the number of BSN-prepared nurses sooner and reciprocally offsets the future demand on postlicensure BSN programs, maximizing future available capacity in RN-to-BSN programs to accommodate ADN nurses deciding to return for a BSN later in their careers. This shift, coupled with the opportunity for more nurses to obtain a BSN degree early in their careers, positions more nurses to consider master's and doctoral degrees within reach as next-step career options. Nineteen CCMNE programs in California currently provide aggregate capacity for 7% of the state's ADN students to obtain a BSN degree through this academic progression model. The potential exists to double the current enrollment in CCMNE programs in the next 2 years through the adoption of CCMNE programs by additional universities and through existing collaboratives expanding academic and service partnerships.

Indeterminate future state funding to public schools presents limitations to building capacity for BSN and higher education pathways in California State universities. BSN programs in private universities, including those offering online programs, present additional options for future CCMNE expansion through public–private partnerships. The extent and feasibility of expansion across all types of BSN programs is also heavily influenced by the ongoing effort and academic service partnerships to negotiate and provide sufficient public health clinical experience for an increased number of BSN students in the state.

Conclusion

HealthImpact has provided statewide leadership to develop new CCMNE programs, including technical assistance to emerging collaboratives in adopting effective strategies gleaned from regional meetings to share progress, support planning, and strengthen success. Continued growth in the number of CCMNE programs and expanded capacity are needed for CCMNE programs to have meaningful impact, ensuring a higher educated nursing workforce in the future. Dedicated effort to monitor progress, to support the awareness and adoption of effective practices, and to ensure that emerging programs are further institutionalized remain priorities for sustainability.

References

Academic Institutions in California With a California Collaborative Model for Nursing Education (CCMNE) Type of Associate Degree in Nursing (ADN)-to-Baccalaureate Degree in Nursing (BSN) Program

Type of Academic InstitutionNo. of Nursing Programs% of CCMNE Programs Provided by 19 Universities in Partnership With 59 Community Colleges
Total BSN programs4928
  California State universities1968
  University of California40
  Private universities2623
Total ADN programs8966
  Community colleges, public7875
  Private colleges110

Operational Definitions and Rationale for California Collaborative Model for Nursing Education (CCMNE) Core Components

Core ComponentOperational DefinitionRationale
Integrated curriculumNursing courses, nursing prerequisites, and general education courses and degree requirements are coordinated between the associate degree in nursing (ADN) and baccalaureate degree in nursing (BSN) degree programs without inadvertent repetition.Achieve authentic, transparent, seamless ADN-to-BSN progression. All components of the ADN and BSN degrees must be specified and aligned.
Shared facultyQualified community college and university faculty collaborate on nursing curriculum development, delivery, and evaluation.Resolutely work together to continuously clarify and reaffirm focus on coordinated quality nursing education outcomes for each degree.
Dual admissionCurrent ADN students are admitted to, and sequentially or simultaneously enrolled in, the postlicensure BSN (RN-to-BSN) program.Engage the ADN student early in BSN progression, shorten time to BSN completion, and coordinate student resources (financial aid, academic advising, and application procedures).
BSN attainable within 1 year of ADN conferralBSN is achievable within 1 calendar year of full-time study after completion of the ADN.Align the ADN (3 years) and ADN-to-BSN (1 year) degree programs to enable completion of BSN degree requirements in a total of 4 years (comparable to prelicensure BSN).
Permanence and sustainabilityAll components of the CCMNE are institutionalized at collaborating community colleges and universities to ensure continuing program viability.Ensure continuing availability of the ADN-to-BSN program by permanent commitment and deliberately planned resource generation and expenditures.

California Nursing Student Completions (Graduations), 2004–2014

Type of ProgramNo. of Student Completions, 2004No. of Student Completions, 2014% Growth
Associate degree in nursing4,4885,916132
Baccalaureate degree in nursing (BSN)1,4794,606311
Entry-level master's191769403
Total (prelicensure)6,15811,291183
Postlicensure BSN (RN-to-BSN)4391,772403
Authors
Dr. Close is Professor, Department of Nursing, Sonoma State University, Rohnert Park, and Ms. Orlowski is Regional Coordinator, California Institute for Nursing and Health Care, Oakland, California.

The authors received funding for this work from the Kaiser Permanente Southern California Community Benefit Foundation Grant. The authors have disclosed no other potential conflicts of interest, financial or otherwise.

The authors thank Judith G. Berg, RN, MS, FACHE, Executive Director, and Diane Welch, MSN, RN, Education Director, California Institute for Nursing and Health Care, for their continued leadership with academic progression and contributions to this article.

Address correspondence to Liz Close, PhD, RN, 5121 Cove Canyon Dr., Apt. B, Park City, UT 84098; e-mail: liz.close@sonoma.edu.

Received: February 02, 2015
Accepted: July 22, 2015

10.3928/01484834-20151110-04

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