Removing Barriers for Nurses

Removing Barriers for Nurses

In the Institute of Medicine’s landmark report on the future of nursing, one of the key takeaways was the importance of boosting the educational level of the country’s nursing workforce.

“Patient needs have become more complicated,” the 2010 report said, “and nurses need to attain requisite competencies to deliver high-quality care. Nurses must achieve higher levels of education and training to respond to these increasing demands.”

In North Carolina, the Foundation for Nursing Excellence had already begun tackling that challenge through the RIBN project. Pronounced “ribbon,” the acronym stands for Regionally Increasing Baccalaureate Nurses. The mission is to improve health outcomes for North Carolinians by increasing the educational preparation and diversity of the nursing workforce. The focus is to remove barriers for students, especially in rural areas.

“A better educated nursing workforce improves the delivery of care at the bedside and opens the pipeline for future faculty, researchers and administrators,” says Polly Johnson, the Foundation’s CEO. “It speaks to all the things we need within our health care system.”

RIBN works through unique partnerships between community or private colleges and state or privately-funded universities. With financial support from The Duke Endowment, the Jonas Center for Nursing Excellence, The Robert Wood Johnson Foundation and the N.C. Area Health Education Centers, project leaders plan for RIBN to be an option for students across the state by 2020.

A Seamless Path

The nursing profession is the largest segment of North Carolina’s health care workforce. In 2011, about 55 percent of the state’s 97,000 RNs held a two-year Associate’s Degree in Nursing (ADN) as their initial degree for licensure. Of those, less than 17 percent had gone on to earn higher nursing degrees, such as a Bachelor’s in Nursing (BSN).

“The challenge for us was, how do we better connect the community college nursing programs with the university programs to break down barriers and create a cost-effective opportunity for a diverse group of students, particularly in rural areas, to earn their BSN,” Johnson says. “We needed to get more nurses in the right places and with the best education possible.”

Coordinated by the Foundation for Nursing Excellence, RIBN offers dual enrollment at a local community college and a partnering university, forging a seamless path to a BSN. It began in North Carolina in 2008 with a grant from the Robert Wood Johnson Foundation’s Partners Investing in Nursing initiative. In 2009, The Duke Endowment awarded a $62,000 grant to support the first RIBN pilot at Western Carolina University and Asheville-Buncombe Technical Community College. A $100,000 grant from the Endowment supported the pilot for an additional two years.

With the first group of students beginning the program in 2010, interest in the model spread quickly. In 2011, a three-year, $1.4 million grant from the Endowment helped RIBN expand statewide – and by 2013, 190 students were enrolled in the RIBN track across five regions. The Endowment’s support continued in 2014 with a two-year grant for $750,000.

Today, North Carolina has eight regional RIBN programs. The newest, in the Piedmont, is offered through North Carolina A&T State University, Davidson County Community College, Guilford Technical Community College, and Vance-Granville Community College.

The program celebrated a milestone in 2014 with six students from the Western North Carolina pilot in RIBN’s first graduating class. Three local hospitals – Park Ridge Health, Pardee Memorial and the Charles George Veterans Administration Medical Center – hired the graduates.

Saving Money

Students take most of their general education and nursing prerequisite courses during the first year, and then complete the associate degree nursing program during their second and third years at the community college. They also take online liberal arts classes from the university each semester. By the end of year three, they have completed their Associate’s Degree in Nursing. That summer, they take their licensure exam to become a Registered Nurse.

In year four, they complete classes at the university to finish their bachelor’s degree. Courses include gerontological and community health nursing, leadership and management, informatics, and research and evidence-based practice. RIBN students have the option to work part time that year as a RN.

“The patients we see on a general medicine unit today would have been in the intensive care unit 20 years ago,” says Leigh Angel, RIBN program director at Western Carolina University. “Managing their care is much more complex and challenging. If we can start nurses in the RIBN program, then we can get them a great education that’s accessible and affordable.”

In total, the program costs students about $17,000, which is $6,850 more than what they would typically pay to earn an Associate’s Degree, but $9,175 less than the cost of a traditional BSN. RIBN students complete the degree in four years.

A recent economic impact study showed that, for students, the RIBN program is financially more worthwhile over a lifetime because they can become more fully engaged in the profession sooner.

The study also showed that hiring RIBN graduates will save hospitals and other providers about $3 million by 2022 and $4 million by 2030. The savings comes from reduced tuition reimbursement costs and reduced turnover.  

Making a Difference

The goal is for more than 170 RIBN graduates to enter the workforce annually beginning in 2020. To fight attrition, project leaders are looking at ways to support students moving through the program.

Increasing diversity is an ongoing goal in recruiting, as well as reaching into underserved rural communities. Studies show that health professionals who train in rural areas are more likely to remain and practice in those same areas.

“We’re seeing the needle move as far as gender and racial and ethnic diversification, but it’s a journey,” says Nettie Evans, program director at the Foundation for Nursing Excellence. “We’re making progress, but we still have work to do.”

Lynnea Skiman was working at an Olive Garden in Asheville when she enrolled in RIBN. She passed her licensure exam earlier this summer and now works part time as an RN in the oncology unit at Mission Hospital. In 2016, she’ll finish her bachelor’s degree at Western Carolina University.

As a single parent, Skiman says RIBN helped her tackle both degrees simultaneously. She wants to stay in Asheville, and eventually earn her Ph.D. She recently received the Rural RIBN Student Award, which recognizes an outstanding student from a Tier 1 and/or Health Professional Shortage Area.

“My 8-year-old daughter has been my biggest motivator,” Skiman says. “She tells everyone that her mommy is going to be a nurse. As for me, I really like the feeling that I can help people and possibly make a difference in someone’s life.” 

Find more information about RIBN.

By offering dual enrollment at a local community college and a partnering university, RIBN forges a seamless path to a BSN.

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Lin B. Hollowell III
Director of Health Care


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