Understanding the Current State of Nursing Academic Progression in the Commonwealth of Pennsylvania: Charting a Course for the Future

Report to Pennsylvania Action Coalition on Academic Progression Nursing conducted by Pennsylvania Coalition for the Advancement of Nursing Education (PCANE) and Pennsylvania Academic Progression in Nursing (PAPiN)

Report delivered April 2016

Understanding the Current State of Nursing Academic Progression in the Commonwealth of Pennsylvania: Charting a Course for the Future Table of Contents Acknowledgements List of Tables Introduction Description of the Problem Purpose of Project Background Nursing Education in the Commonwealth Brief History of PCANE Methodology Graduates Entering the Pennsylvania Nursing Workforce Academic Progression Program Surveys Survey Participants Instrument and Data Collection Findings and Analysis RN Graduates Entering the Pennsylvania Nursing Workforce (NCLEX-RN) Academic Progression Program Survey Data Practical Nursing Program Data Diploma RN Program Data ADN Program Data BSN Program Data Discussion Recommendations Conclusion References Appendices Appendix A Appendix B 2014 Survey: Practical Nursing Program 2014 Survey: Diploma RN Program 2014 Survey: Associate Degree in Nursing Program 2014 Baccalaureate Nursing Degree Program: Survey Appendix C

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Acknowledgements The Pennsylvania Academic Progression in Nursing (PAPiN) leadership would like to acknowledge the many individuals who participated in collecting nursing program survey data, analyzing the data, and drafting this manuscript. The former members of the Pennsylvania Coalition for the Advancement of Nursing Education (PCANE) were responsible for the initial phases of the project. A special note of thanks goes to Dr. Frances Ward whose leadership organized and operationalized the project through the data collection and analysis phases. PAPiN also acknowledges Dr. Debbie Rahn who provided the leadership in transforming the document to its final draft. In addition, PAPiN would like to thank the National Council State Boards of Nursing and the Pennsylvania State Board of Nursing for the availability of the NCLEX-RN data, which has been valuable in establishing current benchmarks for future comparison. PAPiN would further like to thank the Pennsylvania Action Coalition for the opportunity to work collaboratively to establish a strategic plan for achieving the IOM educational recommendations.

2016 PAPiN Co-Leaders: Janyce Collier MSN, RN, CNE

Patty Knecht PhD RN ANEF Mary Jean Osborne DNP, RN

Debbie Rahn EdD, MSN, RN

Nurse Administrator Franklin County Career and Tech Center Practical Nursing Program Chair, Nursing Division Immaculata University Director, Nursing Programs at Northampton Community College Director, RHSHS

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717-263-5667 [email protected]

610-647-4400 Ext 3475 [email protected] 610-861-5375 [email protected] 484-628-0201 [email protected]

List of Tables Table 1.

Table 2. Table 3. Table 4. Table 5. Table 6. Table 7. Table 8. Table 9. Table 10. Table 11. Table 12. Table 13.

NCLEX Data: Percent of First Time NCLEX Test Takers (Delivered Exams) per State per Degree Type (BSN vs. ADN vs. Diploma NCLEX first time test takers)……………...................................... Percent of Individuals per Degree Type Taking NCLEX-RN in Pennsylvania…………………………………………………….... Summary of Best Practices Comments from PN Programs…………... Changing PN-ADN enrollment patterns in the past five years……….. Changing Diploma-BSN enrollment patterns in the past five years….. Summary of Best Practices Comments from Diploma Programs…….. BSN Program Format Types Preferred by Diploma Graduates………. BSN program format types preferred by ADN graduates…………..... Summary of Best Practices Comments from ADN Programs………... Comparison of RN-BSN Enrollment Data Diploma vs. BSN responses Comparison of RN-BSN Enrollment Data ADN vs. BSN responses… Program Comparison for Preferred Delivery Format of RN-BSN Program…………………………………………………………... Summary of Best Practices Comments from Baccalaureate Degree Nursing Programs……………………………………………,,…..

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Understanding the Current State of Nursing Academic Progression in the Commonwealth of Pennsylvania: Charting a Course for the Future

Introduction Description of the Problem The impetus for this manuscript stems from the 2010 Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health, (IOM, 2011) which issued a historic call to action to increase the proportion of nurses with baccalaureate degrees to 80% by the year 2020. According to the IOM report (2011), nurses with Bachelor of Science in Nursing (BSN) degrees possess the skills, knowledge, and abilities needed to manage the increasing complexity of patients, the overall healthcare system, and the community. The Academic Progression in Nursing (APIN) grant awarded to the Tri-Council in 2012 was strategic in assisting states to meet the recommendations of the IOM. Through academic progression, nurses can continue their education following initial licensure (Licensed Practical Nurse (LPN) and Registered Nurse (RN)) to attain higher degrees (BSN through graduate and doctoral degrees) to meet the growing challenges of nursing and healthcare. Historically, graduates from Associate Degree or Diploma RN nursing programs faced multiple obstacles and challenges when seeking flexible educational programs to complete their BSN degrees. Obstacles for RN academic progression have lessened in the last decade as creative, cost-effective, educational models emerged in response to the IOM recommendations. Nationally, options for educational mobility have included newer models such as community colleges providing BSN completion, standardized curricula, dual enrollment programs, RN to the Master of Science in Nursing (MSN) and LPN to BSN programs. Ongoing collaboration within

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the academic and practice nursing communities is necessary to provide cost effective, high quality, seamless academic programs from LPN through doctoral degrees to meet the IOM recommendations. Purpose of Project It is essential that the Commonwealth of Pennsylvania chart a course of action toward achieving the IOM recommendation of 80% baccalaureate educated nurses by 2020. According to the Pennsylvania Department of Health in 2012-2013 RN survey, 39% of respondents listed their highest degree earned as a BSN, followed by 27% with a ADN, 24% with a Diploma in nursing, 9% with a MSN, and less than 1% with a doctoral degree (PA DOH, March 2015). Thus, action is needed to meet this goal. The purpose of this project was to assess educational program data for the Commonwealth by considering the strengths and weaknesses of LPN and RN academic mobility programs, identify academic best practices, and recommend next steps aimed at reaching the IOM recommendation. Background Nursing Education in the Commonwealth A wide variety of nursing educational programs exist in Pennsylvania. The Pennsylvania State Board of Nursing (PA-SBON) approves pre-licensure educational programs which currently include fifty-six (56) Practical Nurse (PN) programs, eighteen (18) Diploma RN programs, twenty-seven (27) Associate Degree in Nursing (ADN) programs, and forty (40) Bachelor of Science in Nursing (BSN) programs (PA-SBON website data updated as of January 20, 2016). Of the twenty-seven ADN programs, two programs (Gwynedd Mercy University and Penn State University) plan to close in 2016 (PA-SBON, 2016). In addition, two Diploma nursing programs have recently announced closure. Temple University’s Northeastern Hospital

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School of Nursing announced the closure of that program effective May 2016 (Northeastern Hospital School of Nursing, 2016). In addition, Abington Dixon School of Nursing, has announced closure of their Diploma program in fall 2017 which will be followed by the opening of a satellite campus of Jefferson University’s BSN Nursing Program BSN (Abington Dixon School of Nursing, 2016). Multiple colleges and universities in Pennsylvania also offer graduate nursing degrees including MSN, Advance Nurse Practitioner, Doctor of Nursing Practice, and PhD in Nursing degrees. Pennsylvania has a statewide Articulation Agreement, adopted by the Pennsylvania Higher Education Nursing Schools Association, Inc. (PHENSA) in 1994, available for viewing on the American Association of Colleges of Nursing website. The statewide agreement allows for each college or university to establish its own admission criteria, admission processes, and transferability standards. Thus, the RN-BSN academic progression models currently in place are institutionally specific with no consistent model utilized throughout the Commonwealth. Existing RN-BSN programs differ in admission processes, seamlessness of enrollment for the ADN/Diploma graduate, number and type of transfer credits awarded, requirements for testing to receive credit, and the number of general education and elective credits permitted to be taken at the pre-licensure level prior to enrollment in the RN-BSN program. Brief History of PCANE In fall 2007, a group of nurses from Pennsylvania met to discuss strategies to achieve higher numbers of baccalaureate-prepared Registered Nurses in Pennsylvania. The initial small group of individuals grew to include representation from all levels of nursing education (practical nursing through graduate nursing education) as well as representation from nursing practice, nurse executives (Pennsylvania Organization of Nurse Leaders (PONL)), the

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Pennsylvania State Nurses Association (PSNA), and other interested stakeholders. The group originally focused on establishing legislation for required BSN completion, known at the time as “BSN in Ten” legislation. The group self-identified as the Pennsylvania Coalition for the Advancement of Nursing Education (PCANE) and met regularly from its inception through 2015 to discuss issues related to nursing education and the achievement of the IOM recommendations. Over time, the group placed more emphasis on improving academic progression within the Commonwealth of Pennsylvania rather than mandating change through legislation. PCANE has produced an important body of work on academic progression. In 2010, PCANE studied barriers to academic progression identified by Diploma RN and ADN students (Maneval & Teeter, 2010). In May 2013, PCANE produced a white paper regarding the early work of PCANE on academic progression (PCANE, May 2013). PCANE surveyed nursing educational programs in Pennsylvania in June 2013 with the purpose of assessing the existence of nurse faculty shortages and the needs of nursing educational programs within the Commonwealth (PCANE, June 2013). As a follow-up, PCANE collected the data presented in this report in the later part of 2014. Additionally, PCANE implemented a work group to focus on nurse residency programs, which evolved into the Nurse Residency Council of the Pennsylvania Action Coalition (PA-AC). One of the most noteworthy accomplishments of PCANE was the enhanced collaboration between all levels of nursing education, as well as nurse executives, nursing service, and nursing professional organizations. This report to the PA-AC serves as the final project for PCANE as a new organizational structure has emerged. Methodology

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The methodology employed for this project included two separate data collection processes. The data collection processes were designed to provide information to the PA-AC to promote change and design quality improvement strategies, rather than to employ a strict scientific research process. Graduates Entering the Pennsylvania Nursing Workforce The first method included a secondary analysis of the National Council of State Boards of Nursing NCLEX-RN Report Number Six entitled “Number and Percent Passing of First Time Candidates Educated in Member Board Jurisdictions, By Degree Type.” Four quarters of data, beginning in October 2014 through September 2015, were compiled from the National Council of State Boards of Nursing NCLEX-RN Report Number Six. The methodology was designed to determine the annual quantity (and percentage) of new RNs graduating with a BSN degree at the time of taking the NCLEX-RN versus the number of new RNs within the Commonwealth who will need to advance their education to achieve the BSN degree. Identifying the degree type of new graduate RNs entry within the Commonwealth provides a snapshot of the educational preparation of the emerging RN workforce. Analyzing this data can assist in determining if the degree type of Pennsylvania’s newly licensed RNs aligns with the IOM recommendation of 80% of RN workforce with a BSN by 2020. Academic Progression Program Surveys The second methodology was designed to collect data describing the current collaborative pathways for educational advancement through the BSN degree within Pennsylvania. In fall 2012, PCANE sent surveys to sixty-nine (69) directors of PN programs, nineteen (19) directors of Diploma RN programs, twenty-six (26) directors of ADN programs, and forty-one (41) directors of baccalaureate and higher degree nursing programs. One section of the 2012 survey

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included questions related to the existence of articulation and dual admission agreements for educational advancement. In fall 2014, PCANE distributed a follow-up survey to the academic administrators of all nursing educational programs in the Commonwealth of PA to further describe the characteristics of the program articulation and dual admission agreements for LPN and RN graduates to advance their education through or beyond the BSN level of education. The goal of the 2014 follow-up survey process was to collect data describing the current (and best) academic progression practices within the Commonwealth, and identify recommendations for achieving the IOM 80% BSN benchmark. The findings in this current manuscript report the data retrieved from the 2014 surveys. Survey Participants. The current list of Practical Nurse, Diploma, ADN, and BSN programs, as published by the PA State Board of Nursing, is provided in Table 1, Appendix A. All (100%) of the educational programs in operation at the time of the surveys were invited to participate in the data collection process. Satellite campuses were invited to complete independent surveys. Instrument and Data Collection. Separate but parallel surveys were created for each education program level including PN, Diploma, ADN, and BSN programs. The surveys were designed to capture the information specific to that educational program type related to academic progression. Copies of the 2014 surveys are available in Appendix B. An email invitation to participate in the survey data collection process was sent by PCANE to each nursing program administrator. Four periodic contacts were made by phone and/or email to facilitate survey response. The surveys requested information about articulation and dual admission agreements (see Appendix B for details). An articulation agreement is defined as a formally written arrangement

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produced when two or more academic institutions follow a process leading to an agreement to provide a formalized pathway for student transfer from one program to the next. In contrast, dual admission agreements establish a process by which a student is admitted to two separate academic institutions. Similar to dual admission, some institutions offer dual enrollment, whereby the student is simultaneously enrolled in two different programs, and may be working on two separate levels of education at the same time. For example, a student could be enrolled in a dual enrollment program whereby the curricula is designed collaboratively between the two institutions and will provide both a diploma and an associate degree at the time of program completion. The surveys analyzed in this report included only articulation and dual admission agreements. Findings and Analysis The data findings are divided into two major sections. The first section describes the new nursing workforce according to degree type at the time of entry into the workforce. This data was secured from the National Council of State Boards of Nursing NCLEX Data reports and compared to national data. The second dataset was collected using surveys distributed and analyzed by members of PCANE. RN Graduates Entering the Pennsylvania Nursing Workforce (NCLEX-RN) NCLEX-RN data collected between October 1, 2014 and September 30, 2015 indicates that slightly less than fifty percent (49.7%) of first time test takers in Pennsylvania graduated from a BSN program. Thirty-six percent (36.2%) of first time test takers in Pennsylvania between October 1, 2014 and September 30, 2015 graduated from an ADN program. Fourteen percent (14.0%) of first time test takers in Pennsylvania between October 1, 2014 and September 30, 2015 graduated from a Diploma RN program. Thus for the given time period, approximately

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fifty percent (49.7%) of new graduates who took the NCLEX-RN to enter the PA workforce had achieved a BSN at the time of entry and the remaining 50.3% had either a Diploma or ADN degree at the time of entry into the Pennsylvania workforce. The state with the highest percent of first time NCLEX test-takers who graduated from a BSN program is North Dakota (78.7%) and the state with the lowest percent of first time NCLEX test-takers who graduated from a BSN program is Wyoming (19.5%). When compared to the fifty states within the United States of America, plus the District of Columbia (n = 51), Pennsylvania ranks 17th out of 51 in regards to the highest percentage of BSN NCLEX-RN testers. Table 1 in Appendix C provides additional data regarding the NCLEX-RN percent of testers national data by degree type. Compared to prior NCLEX-RN data, Pennsylvania has increased the percent of graduates achieving a BSN at the time of entering the workforce. The NCLEX-RN data from October 2012 to September 2013 indicated that only 46% of all Pennsylvania graduates taking the NCLEX-RN had achieved a BSN degree at the time of entry into the workforce. Between October 2012 to September 2013, Pennsylvania ranked 21st as compared to other states in the nation (n = 51). Thus, Pennsylvania has increased the percentage of individuals who have graduated from a BSN program at the time of licensure from 46% in 2013 to 50% in 2015. In addition, Pennsylvania’s national ranking for this statistic has improved from the 21st highest performing state in 2012-2013 to the 17th highest performing state (2014-2015). Table 2 below summarizes the 2013 and 2015 educational level at the time of entry into workforce Pennsylvania data. Table 2 Percent of Individuals per Degree Type Taking NCLEX-RN in Pennsylvania BSN ADN Diploma 2012-2013 46% 40% 14% 8

Rank in USA 21/51

2014-2015

50%

36%

14%

17/51

A second portion of the NCSBN report provides similar data. Rather than providing results related to the number of graduates attempting NCLEX-RN (tests delivered) this portion of the report reflects a state by state comparison of the percent of individuals who passed the NCLEX-RN examination and their degree type at the time of testing. Pennsylvania data reflects that between October 1, 2014 and September 30, 2015, fifty-one percent (51.4) of successful first time test takers in Pennsylvania were graduates from a BSN program. Thirty-five percent (34.6) of successful first time test takers between October 1, 2014 and September 30, 2015 graduated from an ADN program. Fourteen percent (14%) of successful first time test takers between October 1, 2014 and September 30, 2015 graduated from a Diploma RN program. It is important to not confuse this workforce data (degree type/total in PA) with program pass rates (number of passers/takers). These data compare the number of new RNs per degree type and not the pass rate for each degree type. The state with the highest percent of first time successful NCLEX test-takers who graduated from a BSN program was North Dakota (78.2%) and the state with the lowest percent of successful first time NCLEX test-takers who graduated from a BSN program was Wyoming (20.5%). When compared to the fifty states within the United States of America, plus the District of Columbia (n = 51), Pennsylvania ranked 15th in regards to the highest percentage of successful BSN NCLEX-RN testers. These data on the new RN workforce informs an understanding of the challenges in achieving the 80% BSN benchmark by 2020. Although Pennsylvania has made improvements in the percent of BSN entering the workforce when comparing 2013 and 2015 data, Pennsylvania continues to contribute to the gap in the 80% benchmark. In addition to increasing the number of 9

BSN graduates in the current workforce, approximately 60% of the new Diploma and ADN graduates will also need to achieve a BSN in each annual cohort to reach that 80% mark by 2020. While difficult to accurately measure current rates, past reports (Maneval & Teeter, 2010) have indicated that the number of ADN and Diploma graduates returning for a BSN is much less than the 60% needed to reach this benchmark. Therefore, in order to meet the 80% BSN benchmark, Pennsylvania must create an action plan to advance academic progression in nursing. Academic Progression Program Survey Data As previously described, the Pennsylvania Coalition for the Advancement of Nursing Education (PCANE) completed a survey of nursing educational programs in Pennsylvania. This survey revealed that many PN programs, Diploma RN programs, and ADN programs have articulation agreements with baccalaureate nursing programs. The survey findings are divided into four sections as follows: (1) PN program findings; (2) Diploma RN program findings; (3) ADN program findings; and (4) Baccalaureate degree nursing program findings. Participation Rates. From September 9th through December 5th 2014, the 2014 followup surveys were collected from respondents in all four educational sectors. The following response rates were achieved: 

Practical Nursing Program Administrators: 62 surveys were distributed and 43 surveys were returned (69.4% response rate).

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Diploma Nursing Program Administrators: 18 surveys were distributed, and 15 were returned. However, because the Temple University’s Diploma program was slated to close in 2016, that data was not included in the findings. Thus the final number of surveys considered in the analysis was 17, and 14 out of 17 surveys were returned (82.4% response rate).

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Associate Degree Nursing Program Administrators: 27 surveys were distributed and 12 surveys were returned (44.4% response rate).

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Baccalaureate Degree Nursing Program Administrators: 45 surveys were distributed and 31 surveys returned (68.9% response rate).

Practical Nursing Program Data. The PN program survey data indicated that the majority of programs in the Commonwealth did not have any formal PN to ADN articulation agreements. Of the 42 responses to this item, only 33.3% (14) of the PN programs indicated that they had such agreements, while the remaining 64.3% (27) of practical nursing programs indicated that no such agreements existed for their programs. Fourteen PN programs indicated the existence of at least one PN-ADN articulation agreement and also provided additional information related to the articulation agreements. Of the 14, 78.6% (11) indicated that the articulation agreements with ADN programs included criteria that were clearly identified, consistently applied, and published. When asked when students were informed of the articulation agreements with ADN programs, the majority of PN programs with agreements (64.3%) indicated that the PN applicant was informed about the articulation agreements at the time of application to the program. Other participants indicated that they wait to discuss articulation agreements until admission to the PN program (7.1%), at some time during the educational program (21.5%), or immediately prior to graduation (7.1%). Despite the existence of articulation agreements, only 35.7% of programs indicated that the enrollment process occurred automatically without further review of the applicant, with 64.3% of the programs indicating that automatic enrollment was not descriptive for most of the PN-ADN articulation agreements. Likewise, the majority of respondents (71.4%) indicated that PN graduates were required to repeat course content. In addition, the perception of requiring PN

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graduates to repeat already passed coursework received multiple negative comments in the qualitative open-ended questions of the survey. In free-form response, program directors identified two “best practices” for an articulation agreement. Three broad themes emerged in each nursing level: seamless enrollment, appropriate and fair credit awarded, and additional suggestions for articulation program components. The PN responses are grouped thematically in Table 3. Table 3 Summary of Best Practices Comments from PN Programs Theme Responses From Survey Participants Seamless enrollment Criteria for articulation clearly defined for students; Ease of enrollment; passing the NCLEX-PN is the student’s only requirement for acceptance into the program Appropriate and fair credit Remove repetitive requirements (coursework previously awarded passed); offer up to 15 credits toward the associate degree; award credit without challenge examinations; automatic award of credits for PN education; recognition of past academic achievements; ability to test out of Intro to Nursing, OB, pediatrics; ability to test out of OB specialty; use of ATI test scores from the PN program in place of a placement test Establish LPN-ADN-BSN pathway; Colleges classes Suggestions for articulation integrated into the practical nurse program; credit for 6 program components months of work experience; include a role transition course; completion program of PN to ADN in one academic year; One plus One program structure which is one year of PN and one additional year to complete ASN

The PN program survey responses focused on formal PN-ADN agreements, however survey participants also provided information regarding other types of educational advancement agreements. Comments included notations that articulation agreements were believed to be unnecessary because the PN graduates were able to receive some level of advance placement in an ADN program without a formal agreement. In addition, comments indicated that some PN

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programs had articulation agreements with RN-Diploma programs. Two survey participants, representing only 5% of responding PN programs, indicated that they had formal PN to BSN articulation agreements, while forty (40) respondents (95.2%) indicated that they had neither articulation nor dual admission agreements with baccalaureate nursing programs. Survey respondents were asked to describe changes in enrollment practices over the past five years for PN graduates who were pursuing advancing education to the RN level. Forty-one (41) respondents answered this item. Table 4 illustrates the responses. Table 4 Changing PN-ADN enrollment patterns in the past five years Changes in PN-RN Enrollment Pattern Number of Responses Enrollment increased over the past five years 21 (51.2%) Enrollment decreased over the past five years. 0 Enrollment remained stable over the past five years. 6 (14.6%) Unknown 14 (34.2%) TOTAL: 41 (100%)

The final question in the survey was an open-ended question. Comments included PN program plans of creating additional formal articulation agreements with RN Programs, as well as difficulties experienced by PN programs seeking to establish articulation agreements with BSN programs. One respondent wrote, “I have contacted baccalaureate programs within a 50 mile radius of our program. I have not had any (BSN program) willing to have an articulation agreement with us. They all state they allow LPNs to ‘test out’ of certain areas and thus receive up to 6 credits toward their degree, so they see no need for a formal agreement.” Another commented, “I have contacted several local colleges, and they are not currently interested in setting up an articulation agreement since we are 1) a clock hour program; 2) our nutrition, psychology, growth and development content is integrated throughout the program; and 3) the

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institutions will grant a certain number of credits (usually applied to Fundamentals of Nursing) because our graduates are licensed, not because they graduated from our specific PN program.” Diploma RN Program Data. Pennsylvania’s Diploma RN Programs have been actively engaged in developing college and university articulation agreements. All fourteen (100%) of the responding Diploma RN programs indicated that they have formal articulation agreements for completion of the BSN degree. In addition, all programs (100%) indicated that the articulation agreements with BSN programs included criteria that were clearly identified, consistently applied, and published for some (14.3%), if not all (78.6%), of their articulation agreements. Diploma programs indicated that they engage in multiple articulation agreements from a variety of BSN programs to provide more options for their graduates to complete their BSN degree. Eleven respondents (79%) indicated that the applicant was informed about the articulation agreements at the time of application to the program. One school indicated that they wait to discuss articulation agreements until admission to the program, one program informed students at some time during the educational program, and one program waited until immediately prior to graduation to discuss articulation opportunities. Participants were asked if Diploma graduates who met the criteria identified and published in articulation agreements were automatically enrolled in the BSN program without additional review (also referred to as “seamless” enrollment). Only 35.7% of programs indicated that the enrollment process was a seamless process, with 21.4% indicating this was true for “some” articulation agreements and 42.9% of respondents indicating that seamless enrollment was not descriptive for most of the Diploma-BSN articulation agreements. The Diploma program directors were also asked to respond whether graduates are required to repeat already completed coursework when enrolled in the RN-BSN program. Only

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42.9% of respondents indicated that no replication was true for all of their baccalaureate degree articulation agreements. An additional 50% of respondents indicated that no course repetition was accurate for some of their articulation agreements, and one respondent indicated that course replication was required for most of their baccalaureate degree articulation agreements. Lastly, one Diploma RN program used the open-ended questions to raise a concern about a recent decrease in transferable credits (and increase in content replication) associated with individual BSN programs. Thirty six percent (5/14) of the Diploma RN programs indicated that they had dual admission agreements with a college or university, while 64.3% (9/14) did not have dual admission agreements. Of the five programs with dual admission agreements, four programs (80%) indicated that the criteria for dual admission were clearly identified, consistently applied, and published. Students in the Diploma program were informed about the dual admission processes either at the time of application (80%) or immediately upon admission to the program (20%). According to survey respondents, all students (100%) dually admitted to both programs are able to progress in the curriculum to a BSN without content repetition. Survey participants were asked to estimate the number of months needed for Diploma graduates to complete their baccalaureate degree nursing program on a full-time basis. Responses ranged from 6 months to 24 months. When asked about the timeframe to complete the BSN degree on a part-time basis following graduation from a Diploma program, the responses ranged from 12 months to 32 months. Survey respondents were asked to describe changes in enrollment practices over the past five years for Diploma graduates who were pursuing additional education to the BSN level. Fourteen respondents answered this item, and Table 5 illustrates the responses.

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Table 5 Changing Diploma-BSN enrollment patterns in the past five years Changes in Diploma-BSN Enrollment Pattern Number of Responses Enrollment increased over the past five years 11 (78.57%) Enrollment decreased over the past five years. 0 Enrollment remained stable over the past five years. 0 Unknown 3 (21.43%) TOTAL: 14 (100%)

Program Directors were asked to define two “best practices” for articulation and/or dual admission agreements. The responses are grouped by theme in Table 6. Table 6 Summary of Best Practices Comments from Diploma Programs Theme Responses From Survey Participants Seamless enrollment Seamless Progression; ease of moving into the completion program; no minimum GPA; no need to reapply; congruent pre-requisites; no further admission requirement beyond completion of an accredited nursing program and RN license. Appropriate and fair credit No duplication of coursework [mentioned by many awarded responding programs]; accept credit for RN license without replication of course content; transfer of nursing credits as a minimum of 40 credits in the nursing requirements and transfer of all college course credits; BSN program accepts up to 60 credits from pre-licensure program; and recognition of the advancement and changes in Diploma programs and curricula (rather than assuming the education is the same as in the distant past). Suggestions for articulation Student access to university support services; ability to program components dual enroll; tuition discount; establish more RN-MSN articulation agreements; reasonable cost, reasonable time frame (