SYSTEMATIC REVIEWS AND META-ANALYSES

Contents lists available at ScienceDirect

Journal of Professional Nursing

journal homepage: www.elsevier.com/locate/jpnu

Best practices and lessons learned in academic progression in nursing: A scoping review Leigh Angel University of North Carolina at Greensboro, 1400 Spring Garden St, Greensboro, NC 27412, United States of America

A R T I C L E I N F O

Keywords: Academic progression Partnership models Regionally increasing baccalaureate nurses

A B S T R A C T

Background: The movement to advance academic preparation of entry-level nurses to the baccalaureate degree across the United States (U.S.) prompted the emergence of collaborative academic progression models. Since the National Academy of Medicine's (2010) call to action, nine states responded with academic progression colla- boration models of nursing education to address the nursing shortage and prepare nurses for the increase in healthcare complexity. Purpose: The purpose of this scoping review is to examine key features including best practices and lessons learned of academic progression initiatives in nine states: California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington. States that established academic progression models later are also included in this review. Methods: The Joanna Briggs Institute (JBI) procedures for scoping review were implemented to synthesize lit- erature from multiple relevant sources including peer-reviewed journals and gray literature. Results: Best practices of academic progression models include local collaboration between academic institutions and program policy such as articulation agreements, seamless progression, and course transfer. Lessons learned include dissonance in faculty advising, employer support, and a paucity of data for robust program evaluation. Conclusions: Academic progression models that not only remove barriers for students to attain the BSN degree but also facilitate collaboration and innovative learning demonstrate success in promoting meaningful academic progression and education mobility.

The landscape of healthcare is changing dramatically; increasing demand for highly competent nurses stems from advances in tech- nology, an aging population, and increases in chronic conditions (Heron, 2018; Salmond & Echevarria, 2017). Policy and economic drivers such as healthcare reimbursement models demand efficiency in care delivery as access to healthcare becomes more available through insurance coverage and healthcare costs skyrocket (Fischer, 2016; Zittel, 2018). Registered Nurses (RNs) are the largest sector of health- care professionals and are expected to enter practice with increased competencies to coordinate care, lead teams, and use evidence-based practice to ensure patient safety (Bureau of Labor Statistics [BLS], 2019).

In its 2011 landmark report, the National Academy of Medicine (NAM) (2011) 1) issued a call to action to increase the proportion of nurses prepared at the baccalaureate level or higher to 80% by 2020. To meet the demands of the healthcare system, the nursing education system is charged with developing innovative ways to meet the in- creased demand for BSN nurse graduates. The nursing profession cur- rently has multiple options for academic preparation (e.g. diploma,

associate, baccalaureate, and entry-level masters) yet all graduates are eligible and take the same national licensure exam to enter into practice (Spetz, 2018). With the National Council Licensure Examination (NCLEX), all nursing graduates demonstrate the same minimal level of competency but are faced with a vast range of care settings, complexity of patient care, and challenging industry demands.

Answering the NAM call to action, the Academic Progression in Nursing (APIN) task force was created and funded by the Robert Wood Johnson Foundation (RWJF) to stimulate efforts in nursing education communities to innovate new ways of advancing nursing education (Farmer, Gerardi, Thompson, & Hoffman, 2017). Applications were reviewed and the APIN task force selected nine states to receive $300,000 in funding over two years to implement projects that would promote academic progression in nursing (Farmer et al., 2017; Gorski, Farmer, Sroczynski, Close, & Wortock, 2015). Shifting the proportion of bachelor of science in nursing (BSN) nurses to 80% has shown to be difficult and multi-faceted; current data indicate an 8% growth in BSN nurses since 2010 (2010 = 49%; 2018 = 57%) (Campaign for Action, 2017). A review of literature reveals best practices and lessons learned

https://doi.org/10.1016/j.profnurs.2020.08.017 Received 23 April 2020; Received in revised form 21 August 2020; Accepted 26 August 2020

E-mail address: [email protected].

Journal of Professional Nursing 36 (2020) 628–634

Available online 27 August 2020 8755-7223/ © 2020 Elsevier Inc. All rights reserved.

T

from the nine APIN initiatives and highlights recommendations for continued progress to transform nursing education and achieve the IOM goal. For this article, academic progression is defined as educational mobility from the associate degree in nursing (ADN) to a BSN degree; collaborative partnerships supported by the APIN task force are aca- demic progression models.

Implementation of the APIN initiatives across the country generated dissemination of valuable information presented in a variety of loca- tions such as peer-reviewed journals and gray literature such as non- refereed journals, reports, and presentations. Articles included in this scoping review describe respective academic progression model fea- tures and highlight the implementation of characteristics from other academic progression models that fit best within the specific state. Because the descriptive literature highlights individual models and provides a narrow perspective of academic progression across the na- tion this scoping review aims to synthesize relevant information to identify best practices and lessons learned from academic progression initiatives in the nine APIN grant-funded states, as well as other states who developed initiatives outside of APIN grant funding.

Methods

Utilizing a scoping review protocol from the Joanna Briggs Institute (JBI), the following steps were completed to conduct this review: es- tablishment of objectives, development of a question, establishment of inclusion and exclusion criteria, gathering relevant literature, and synthesizing findings. Table 1 details the JBI scoping review protocol used. The research question developed to guide the scoping review was: what are the best practices and lessons learned from academic pro- gression initiatives of the nine APIN grant-funded states and other later implemented initiatives?

Databases searched included the Cumulative Index of Nursing and Allied Health Literature (CINAHL) yielding peer-reviewed literature, and Google Scholar displayed peer-reviewed literature as well as re- levant gray literature. Internet-based searches for the APIN grant-

funded states led to presentations, reports, and relevant organization websites. Search terms used were academic progression and nursing and terms related to specific academic progression models such as Regionally Increasing Baccalaureate Nurses (RIBN) and Oregon Consortium for Nursing Education (OCNE).

Inclusion criteria included literature focusing on collaborative aca- demic progression models between community colleges and uni- versities in APIN grant-funded states and other non-APIN grant-funded states. Literature excluded from analysis were articles related to tradi- tional types of nursing education such as RN-BSN programs in which a student enters a BSN completion degree program. Other exclusions were practice partner and academic partner collaborative models, hospital-based RN-BSN completion models, accelerated BSN programs in which a student who holds a non-nursing bachelor degree can attain a BSN degree within three years, new graduate nurse workforce tran- sition, and student barriers preventing progression within a nursing program such as resources and family demands. Although articles that are more recent provide insight to answer the research question, his- torical perspectives of efforts to establish academic progression part- nerships are critical to providing context and background to the lit- erature search. Therefore, search dates were expanded to 2010 to present.

Results

Search results in both databases yielded 56,498 articles and cita- tions. Results were sorted by relevance and duplicate articles were re- moved. Abstracts were reviewed for inclusion and exclusion criteria and 33 articles were selected for the scoping review. The citations were entered into a spreadsheet and sorted by publication date and state or national focus. Nineteen articles were from APIN grant-funded states and 10 articles were based on national level descriptions of academic progression models. Six articles were published regarding academic progression initiatives in non-APIN grant-funded states. Results are discussed below by state and national level findings. Reviewed state level literature is included in Tables 2 and 3; national-level literature is included in Table 4.

State-level literature

On a state level, groups from five APIN grant-funded states in- cluding California, Hawaii, New Mexico, North Carolina, and Texas published 19 articles. 17 of these state publications were retrieved from national or state-level peer-reviewed journals and the remaining two articles were published by non-refereed organizations; an economic business analysis and economic impact publication authored by the North Carolina Foundation For Nursing Excellence (FFNE) and an in- ternal organization commentary (Didow, 2015; Hooper, 2013). De- scriptive articles discussing key features of the respective APIN models describe dual admission to both a community college and university to allow for seamless progression from the ADN to BSN nursing programs (Close & Orlowski, 2015; Hall et al., 2012; Johnson, 2014); integrated curricula in which some programs allow students to enroll in BSN level courses while also enrolled in the ADN nursing program (Giddens et al., 2015; Giddens & Meyer, 2016; Landen et al., 2017). Non-APIN grant- funded states published six articles in peer-reviewed journals focusing mainly on descriptions of academic progression models. One qualitative study was reviewed from non-APIN grant-funded programs in Illinois in which deans of ADN (N= 5) and BSN (N = 3) nursing programs were interviewed as part of a gap analysis investigating the impact of ar- ticulation agreements on educational mobility (Yambo, 2018). While the descriptive publications detailed similar foundational elements of academic progression initiatives such as articulation agreements, the qualitative study revealed inconsistency with structure and record- keeping of the academic progression models (Yambo, 2018).

Table 1 JBI scoping review protocol.

Scoping Review title: Academic Progression in Nursing Review objective/s: Review literature on APIN Academic Progression models as well

as other states who developed Academic Progression models outside of the APIN grant funding throughout the US for best practices and lessons learned.

Review question/s: What are the best practices and lessons learned of academic progression models within the nine APIN grant-funded states and other states?

Inclusion/Exclusion Criteria: Inclusion: Academic progression from an APIN grant-funded state, academic progression collaborative partnership models between community colleges and universities

Exclusion: Traditional RN-BSN programs, focus on practice partner-academic partner, accelerated BSN programs, 3-year BSN program, new graduate workforce transition, hospital-based RN-BSN programs, student barriers for progressing within a nursing program

Population: States included in the original APIN grant funding and states that developed academic progression models outside of the APIN grant funding

Concept: best practices and lessons learned Context: academic progression in nursing education to increase educational mobility

from associate degree nurse to baccalaureate prepared nurse Types of Study: descriptive, qualitative, quantitative, commentary, program reports Study Details and Characteristics (all scoping review data compiled on excel

spreadsheet) Study citation details (e.g. author/s, date, title, journal, volume, issue, pages) Source Date State Details/Results extracted from study (in relation to the concept of the scoping

review) Best practices Lessons learned Overall synthesis

L. Angel Journal of Professional Nursing 36 (2020) 628–634

629

National level literature

Eight articles focusing on academic progression efforts that were either not state-specific or focusing on national efforts to move toward the BSN degree for entry into practice were located in peer-reviewed journals and one report found on the National Education Progression in Nursing (NEPIN) website (Farmer et al., 2017). The national level lit- erature includes not only descriptions of academic progression models, but also evaluates the effectiveness of initiatives to increase the pro- portion of BSN nurses to 80% (Farmer et al., 2017; Spetz, 2018).

Themes

Four themes of best practices emerged from national and APIN state publications: collaboration through building on the strengths of the

ADN programs and valuing BSN programs (Bacon & Newton, 2014; Dickerson, 2014; Hall et al., 2012; Knowlton & Angel, 2017; Landen et al., 2017; Magnussen et al., 2013; Metcalfe et al., 2017), streamlining of BSN education through curriculum design (Dickerson, 2014; Giddens & Meyer, 2016; Reid et al., 2017), dual enrollment and seamless pro- gression at partnering community colleges and universities (Dickerson, 2014; Giddens et al., 2015;Knowlton & Angel, 2017 ; Reid et al., 2017), and intentional advising practices to support students (Dickerson, 2014; Knowlton, 2017). Four themes of lessons learned appearing in the APIN state publications include: funding for BSN programs (Close & Orlowski, 2015; Didow, 2015; Schuler et al., 2017), advising and stu- dent support (Knowlton & Angel, 2017; Sportsman & Allen, 2011), curriculum design specific to BSN curriculum (Knowlton & Angel, 2017; Reid et al., 2017), and admission and recruitment practices (Metcalfe & Neubrander, 2016). Curriculum design emerged as a theme for both

Table 2 Review of APIN grant-funded state articles.

Citation Setting Lessons Learned Best Practices

Bacon and Newton (2014) North Carolina

Collaboration: Local collaboration between ADN and BSN programs are critical to meet healthcare workforce demands.

Close and Orlowski (2015) California BSN Funding: Program sustainability due to limited state funding; curriculum redesign to ensure adequate clinical placement for BSN public health course

Program design: Dual enrollment; integrated ADN and BSN curriculum; shared faculty

Dickerson (2014) North Carolina

Curriculum design: Curriculum redesign to ensure adequate clinical placement for BSN public health course

Collaboration: Local program policy: articulation agreements to foster educational mobility; ADN advising is supportive of BSN educational goals

Didow (2015) North Carolina

Program funding: Cost savings recognized by employers of graduates from academic progression model programs prompt financial contributions to respective academic institutions.

Cost savings for employers of graduates from academic progression model programs such as tuition reimbursement and higher quality performance measures such as decreased length of stay and hospital-acquired infections

Giddens and Meyer (2016) New Mexico Transferability of ADN course credits to BSN programs. Curriculum design: compared ADN and BSN curriculum to reduce redundancy, which led to collaborative efforts and faculty sharing.

Giddens, Keller, and Liesveld (2015)

New Mexico Collaboration: ADN and BSN faculty collaborated to teach shared content on the community college campus.

Hall, Causey, Johnson, and Hayes (2012)

North Carolina

Description of original program design did not identify lessons learned.

Collaboration, Dual admission/Seamless progression: Local program policy: dual admission, seamless progression, and institutional collaborative partnerships

Hooper (2013) North Carolina

Increased eligibility for educational mobility to pursue graduate level education for advanced practice nursing.

Johnson (2014) North Carolina

Advising/Student support: Advising at the community college level is not consistently supportive of BSN attainment.

Advising practices: Student Success Advocate (SSA) is a significant supportive measure at the community college level to increase program retention.

Johnson, Hall, and Causey (2011)

North Carolina

Intention of the NC academic progression model is the increased pipeline of students eligible to pursue graduate education to become nursing faculty.

Program design: Dual admission and enrollment at Community College and University; seamless progression; student success advocate

Knowlton (2017) North Carolina

Students experience increased stress during final year of the program related to new nurse transition to professional work and full-time BSN curriculum.

Advising practices: Qualitative study of social worker graduate student facilitating focus groups to address student stressors.

Knowlton and Angel (2017) North Carolina

Advising/student support, BSN curriculum: Individual advising for students with transfer credits; redesign BSN curriculum for meaningful public health clinical experiences

Collaboration: Collaboration with practice partners which has enhanced the employment diversity of senior RIBN students who are able to practice as an RN.

Landen, Evans-Prior, Dakin, and Liesveld (2017)

New Mexico Collaboration: Highly integrated academic model that offers shared curricula and community colleges are able to confer BSN degrees.

Magnussen et al. (2013) Hawaii Collaboration: Collaborations between the island community colleges and university led to quality improvement of all curriculum

Metcalfe and Neubrander (2016)

North Carolina

Admission/recruitment: local policy to implement holistic review to increase student diversity

Metcalfe et al. (2017) North Carolina

Collaboration: mentoring program with faculty and practicing nurse professionals to support student success and program retention.

Reid, Tart, Tietze, Joseph, and Easley (2017)

Texas Curriculum design: Surveyed practice partners and nurse leaders to integrate more leadership content into curriculum to better prepare graduates for nursing leadership roles.

Schuler, Polly) Johnson, Stallings, and Li (2017)

North Carolina

Funding for BSN program: Dissonance in value of BSN degree from practice partners, so employers are not financially contributing to academic progression models.

Sportsman and Allen (2011) Texas Advising/Student Support: Dissonance between students and ADN faculty. Students want to be dual enrolled and complete the BSN degree sooner while faculty are less supportive of the additional workload of dual enrollment BSN course work.

L. Angel Journal of Professional Nursing 36 (2020) 628–634

630

best practices and lessons learned (Dickerson, 2014; Giddens & Meyer, 2016; Knowlton & Angel, 2017; Reid et al., 2017) and is discussed below in the context of best practices.

Discussion

Oregon Consortium for Nursing Education (OCNE) pioneered the first academic progression model in 2001 and efforts to increase nursing education through partnership and collaboration garnered substantial momentum in the last two decades (Gubrud et al., 2017). Although nine states received grant funding to implement academic progression models, other states continued in their efforts. With OCNE as an ex- ample, states learned and adapted the OCNE model to fit their own state and regional education systems. The scoping review of literature re- vealed four themes of best practices and four themes of lessons learned of academic progression models at state and national levels.

Best practices

Collaboration Fifteen publications in both state and national level literature dis-

cussed collaborative efforts as an essential element to successful aca- demic progression models. Collaboration between institutions helps to recognize the strength and value of community colleges; preparing competent nurses (Bacon & Newton, 2014; Close & Orlowski, 2015; Gubrud et al., 2017), increasing diversity in the student population (Godfrey & Blubaugh, 2017; Gorski et al., 2015) and the volume of nurses produced from ADN programs exceeds the capacity of BSN programs thereby creating a necessity for partnership (Gorski & Polansky, 2019; Spetz, 2018). For example, Kumm and Laverentz (2019) describe a benefit of an academic progression collaborative partnership as an increased preference and employability of program graduates because of the association with the BSN program.

Other benefits of collaboration include increasing access to BSN

Table 3 Non-APIN grant-funded state articles.

Citation Setting Lessons learned Best practices

Anderson, Wells, Mather, and Burman (2017)

Wyoming Seamless progression: original design of program did not include seamless progression and program attrition became a substantial problem

Godfrey and Blubaugh (2017)

Kansas Advising/student support: recommendation to create pathways to support students and educational mobility to pursue graduate level education beyond the BSN degree

Curriculum design/collaboration: BSN curriculum is interspersed through ADN program which allows for faculty collaboration

Gubrud, Spencer, and Wagner (2017)

Oregon Advising/student support: students need increased support to cope with stressors of academics, personal life, and role transition as a new graduate RN

Collaboration: success with collaborative statewide curriculum committees to remove redundancy and share resources

Kumm and Laverentz (2019)

Mid-western state

Program design/Collaboration: found success with seamless progression and dual enrollment of ADN and BSN courses so that both degrees are awarded at the same time; collaboration of ADN programs with BSN programs increased graduates' employability with local practice partners.

Masters (2015) Mississippi Advising/student support: virtual advising sessions helped students feel engaged with the BSN faculty in rural settings

Yambo (2018) Illinois Collaboration: intentional collaboration is needed to facilitate student progression and program retention beyond inconsistent articulation agreements

Table 4 National level articles.

Citation Setting Lessons learned Best practices

Farmer et al. (2017) National Collaboration, Program design: intentional collaboration and structured design of the academic progression model maintained program retention rather than having only articulation agreements in place.

Gerardi (2015) National Admission; BSN curriculum: standardization of admission requirements and BSN curriculum design

Program design: removes barriers to the BSN program.

Gerardi (2017) National Collaboration: successful programs include strong partnerships and supportive leadership

Gerardi, Farmer, and Hoffman (2018)

National Advising/student support: programs need to have strong advising and student support structures to facilitate progression versus removing barriers to make the progression pathway easier for students.

Gorski et al. (2015) National Collaboration: statewide and regional collaboration fosters dissemination of best practices and sharing of resources

Gorski and Polansky (2019) National Collaboration: necessary to create change in nursing education that meets the goals of enhanced nursing workforce

Jellinek, Reinhardt, Ladden, and Salmon (2015)

National Funding: Local and regional stakeholders need to be engaged and supportive to make a meaningful impact in nursing.

Pittman, Kurtzman, and Johnson (2014)

National Program design: successful strategy for program retention and educational mobility for students to attain graduate level education.

Price (2014) National Program design: facilitates educational mobility and keeps students engaged for program retention

Spetz (2018) National Collaboration: BSN programs do not have capacity to meet nursing workforce demands and need to partner with ADN programs to produce BSN nurses

L. Angel Journal of Professional Nursing 36 (2020) 628–634

631

education for ADN students particularly in rural areas where BSN programs are scarce (Masters, 2015). The Revolutionizing Nursing Education in Wyoming (ReNEW) model facilitates collaboration and partnership of six community colleges and the University of Wyoming, which has the state's only BSN nursing program. By joining at the state level, the community colleges and students benefit from access to university resources and the university benefits from increased enroll- ment in the BSN program (Anderson et al., 2017). Collaborating also supports the nursing workforce by elevating the employability of ADN graduates to Magnet or Magnet-seeking hospitals (Knowlton & Angel, 2017; Kumm & Laverentz, 2019).

State, regional, and local collaborations and partnerships are ne- cessary to implement change in nursing education (Magnussen et al., 2013). National recommendations can signal the need for reform in nursing education, but meaningful change takes place at the state, re- gional, and local levels to generate new ideas and make decisions (Jellinek et al., 2015). By fostering academic collaboration and part- nerships, educational mobility is enhanced and increases student elig- ibility to pursue graduate level nursing education further advancing the nursing profession and workforce (Pittman et al., 2014; Price, 2014).

Curricula redesign As the need for a more highly educated nursing workforce increases,

nurse educators are evaluating nursing curricula to ensure students are learning effectively and demonstrating higher levels of competency to manage the complexities of the healthcare system they will encounter upon graduation. Curricula redesign in academic progression models, such as concept-based curriculum, is crucial to minimizing redundancy in ADN and BSN course content and to build on the students' prior knowledge (Dickerson, 2014; Giddens & Meyer, 2016; Gorski et al., 2015). Academic progression models also find success with curricula redesign by removing curriculum barriers to facilitate educational ef- ficiency such as many pre-requisite and unnecessary courses as possible (Close & Orlowski, 2015).

Curricula sequencing of interspersing the BSN curriculum throughout the ADN program is not only an innovative way to deliver curriculum in an academic progression model but could also enhance student learning outcomes by increasing faculty support and resources from both ADN and BSN programs (Godfrey & Blubaugh, 2017). No studies were reviewed that formally explored the effectiveness of in- terspersing BSN curriculum through the ADN curriculum and its impact on specific student learning outcomes or NCLEX success.

As the BSN portion of academic progression models is commonly delivered in an online format and BSN enrollment increases by com- bining academic progression students with students already enrolled in other traditional BSN programs, curricula should be evaluated to ensure meaningful learning experiences occur if clinical placement is required (Close & Orlowski, 2015; Knowlton & Angel, 2017). For example, clinical placements for courses such as community health can be limited because of lack of clinical sites, multiple requests for placements from area nursing programs as well as limited preceptors to support student clinical experiences.

To make academic progression more meaningful for students, the BSN curriculum should be redesigned to build on prior ADN content with new BSN content and integrate experiential learning as the student transitions from the community college to the university while also working as a new graduate RN (Knowlton & Angel, 2017; Metcalfe & Neubrander, 2016). BSN curricula should also create meaningful learning clinical experiences in public health courses with high demand clinical sites (Close & Orlowski, 2015). For example, a public health clinical experience could focus on leadership and planning of an in- fluenza vaccine clinic rather than having the student staff the influenza clinic and practice injection administration technique.

Program design Attrition and stop out are problematic for academic progression

models, particularly when students choose to leave the program once the ADN degree is conferred and the student attains professional li- censure (Gubrud et al., 2017). Strategies to prevent attrition and stop out include dual admission and dual enrollment at both community college and university institutions (Gubrud et al., 2017; Hall et al., 2012), seamless progression from the ADN to BSN nursing programs, and conferring both the ADN and BSN degrees at the completion of the entire program (Kumm & Laverentz, 2019).

Strategies such as seamless progression, dual admission, and im- plementation of university centers on community college campuses are efforts to engage students and remove barriers in their academic pro- gram (Gerardi, 2015; Gerardi, 2017; Price, 2014). The final APIN report highlights a few of the APIN models and the consistent thread through all of the programs is the removal of barriers for students to attain the BSN and necessity of partnership and collaboration between institu- tions, policymakers, and practice partners to establish a smooth pathway for students (Farmer et al., 2017; Gerardi et al., 2018). These program design strategies are foundational to ensuring a smooth tran- sition from the ADN to BSN, but truly engaging and supporting students to reach and find meaningful value in the BSN degree is ideal (Fitzgerald, 2016).

Advising and student support The North Carolina academic progression model titled Regionally

Increasing Baccalaureate Nurses (RIBN) allocated substantial funds and intention to develop a paid position for a Student Success Advocate (SSA) (Johnson, 2014). The SSA role advises and mentors the students through their time at the community college and prepares them for the BSN education at the end of the program. Support from the SSA is valuable for student retention (Dickerson, 2014). In more geo- graphically widespread programs, virtual advising is utilized to help ADN students feel connected to the university and view themselves as part of the larger institution generating pride and engagement (Masters, 2015).

Lessons learned

Funding Although grant funding supported the startup of academic pro-

gression in nine states, several other states were already engaged in academic progression model development without grant funding. Some states do find limited funding support hinder the university's ability to manage the increase in BSN students (Close & Orlowski, 2015). As such, Didow (2015) conducted an economic analysis and projected cost savings for employers of graduates from the academic progression programs; costs for tuition reimbursement for BSN education programs is projected to decrease and performance measures such as hospital- acquired infections should improve with a more skilled and competent nursing workforce. To share in the cost benefits, employers are en- couraged to contribute financially to collaborating academic institu- tions to help offset the cost of faculty to ensure the program's success (Didow, 2015). While practice partners and healthcare employers are encouraged to contribute financially to nursing education programs, Schuler et al. (2017) note a dissonance in the perceived value of the BSN degree; employers prefer to hire BSN RNs but are hesitant to fi- nancially support academic institutions to prepare BSN RNs for em- ployment.

Advising and student support Employers need to support academic progression models not only

with financial support to the academic institutions (Didow, 2015) but also by supporting ADN-BSN students with flexible scheduling and support resources as students continue the BSN education and transi- tion into their roles as a new RN (Knowlton & Angel, 2017). Community colleges may experience issues with advisors and counselors not pro- moting academic progression at a university even when the program is

L. Angel Journal of Professional Nursing 36 (2020) 628–634

632

approved through the college and students are eligible to enroll (Masters, 2015; Sportsman & Allen, 2011). The role of the Student Success Advocate is critical to thorough and supportive advising.

Educational mobility While removing barriers from the student's pathway from ADN to

BSN nursing education, the academic progression models support stu- dents to continue on a path of lifelong learning even beyond the BSN degree (Godfrey & Blubaugh, 2017; Yambo, 2018). For example, the academic progression model in Kansas demonstrated a higher program retention rate (93.4%, N = 61) compared to the traditional BSN model (92.5%, N = 311) indicating an increase in students eligible to take graduate level courses. Academic progression models should consider ways to support students from the ADN degree to graduate level pro- grams (Hooper, 2013; Masters, 2015).

Limitations

Limitations of this scoping review are variable amounts of pub- lications from APIN grant-funded states creating a lack of current and disseminated knowledge from each state. Not all APIN grant-funded states were thoroughly reviewed as APIN states published variable amounts of literature. Additionally, results of the scoping review are not empirical or based on program evaluation data and therefore make the findings useful for working knowledge rather than program revisions.

Conclusion

Lessons learned from results and analysis of this scoping review of academic progression models broadly across the nation revealed cur- riculum design as a critical strategy to improve efficiency, infuse cur- riculum with meaningful learning experiences, and inspire educational mobility. Advising and student support are also lessons learned to guide students through the program and equip graduates to enter the nursing workforce prepared to face the complexities of today's healthcare system. Program design such as seamless progression and dual admis- sion are effective strategies to enhance program retention.

Although a meager start with one state, academic progression ef- forts have been implemented in the U.S. for almost 20 years and have gathered a powerhouse of momentum to sweep much of the nation. The movement is small, but steady as reflected in the 8% increase in the number of BSN nurses within the last 10 years. By disseminating in- formation on best practices and lessons learned from current academic progression models, other states can avoid pitfalls and create mean- ingful programs that promote lifelong learning and impact positive outcomes.

Declaration of competing interest

None.

References

Anderson, J., Wells, K., Mather, C., & Burman, M. E. (2017). ReNEW: Wyoming’s answer to academic progression in nursing. Nursing Education Perspectives, 38(5), E18–E22. https://doi.org/10.1097/01.NEP.0000000000000207.

Bacon, T. J., & Newton, W. P. (2014). Innovations in the education of health profes- sionals. North Carolina Medical Journal, 75(1), 22–27.

Bureau of Labor Statistics [BLS] (2019). U.S. Department of Labor. Occupational Outlook Handbook, registered nurses. Retrieved from https://www.bls.gov/ooh/healthcare/ registered-nurses.htm.

Campaign for Action (2017). Dashboard indicators. Washington, DC: AARP. Retrieved from https://campaignforaction.org/resource/dashboard-indicators/.

Close, L., & Orlowski, C. (2015). Advancing associate degree in nursing-to-baccalaureate degree in nursing academic progression: The California collaborative model for nursing education. Journal of Nursing Education, 54(12), 683–688. https://doi.org/10. 3928/01484834-20151110-04.

Dickerson, K. (2014). A community college’s perspective on the RIBN initiative. North Carolina Medical Journal, 75(1), 40. https://doi.org/10.18043/ncm.75.1.40.

Didow, P. N. (2015). RIBN business case analysis and economic impact: Executive sum- mary and recommendation. Foundation for Nursing Excellence. 1–12.

Farmer, P., Gerardi, T., Thompson, P., & Hoffman, B. (2017). Academic progression in nursing (APIN): Final program summary and outcomes. Academic Progression in Nursing, 1–56. https://nepincollaborative.org/apin-final-program-summary- outcomes/.

Fischer, K. (2016). How the educational funding provisions of the patient protection and affordable care act will affect the nursing shortage in the United States. Northwestern Journal of Law and Social Policy, 11(1), 54–77.

Fitzgerald, A. M. (2016). The experience of professional identity development in gradu- ating nursing students. PhD Dissertation Scholarship & Creative Works @ Digital UNCUniversity of Northern Coloradohttps://digscholarship.unco.edu/dissertations/ 322/.

Gerardi, T. (2015). The academic progression in nursing initiative: The halfway point. Journal of Nursing Administration, 45(11), 3.

Gerardi, T. (2017). The academic progression in nursing initiative: The final year out- comes. Journal of Nursing Administration, 47(2), 74–78. https://doi.org/10.1097/ NNA.0000000000000441.

Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. American Journal of Nursing, 118(2), 43–45.

Giddens, J., Keller, T., & Liesveld, J. (2015). Answering the call for a bachelors-prepared nursing workforce: An innovative model for academic progression. Journal of Professional Nursing, 31(6), 445–451. https://doi.org/10.1016/j.profnurs.2015.05. 002.

Giddens, J. L., & Meyer, D. (2016). Foundational courses for the baccalaureate nursing degree: Enhancing efficiency for academic progression. Journal of Nursing Education, 55(7), 373–378. https://doi.org/10.3928/01484834-20160615-03.

Godfrey, N., & Blubaugh, M. (2017). From innovative idea to state-supported policy: Academic progression in prelicensure registered nurse education using the partner- ship model. Journal of Nursing Regulation, 8(3), 12–17. https://doi.org/10.1016/ S2155-8256(17)30155-2.

Gorski, M. S., Farmer, P. D., Sroczynski, M., Close, L., & Wortock, J. M. (2015). Nursing education transformation: Promising practices in academic progression. Journal of Nursing Education, 54(9), 509–515. https://doi.org/10.3928/01484834- 20150814-05.

Gorski, M. S., & Polansky, P. (2019). Accelerating progress in seamless academic pro- gression. Nursing Outlook, 67(2), 154–160. https://doi.org/10.1016/j.outlook.2018. 11.008.

Gubrud, P., Spencer, A. G., & Wagner, L. (2017). From start-up to sustainability: A decade of collaboration to shape the future of nursing. Nursing Education Perspectives, 38(5), 225–232. https://doi.org/10.1097/01.NEP.0000000000000212.

Hall, V. P., Causey, B., Johnson, M.“. P., ”., & Hayes, P. (2012). Regionally increasing baccalaureate-prepared nurses: Development of the RIBN model. Journal of Professional Nursing, 28(6), 377–380. https://doi.org/10.1016/j.profnurs.2012.04. 015.

Heron, M. (2018). Deaths: Leading Causes for 2016. National Vital Statistics Reports, centers for disease control and. Prevention, 67(6).

Hooper, V. D. (2013). The Institute of Medicine report on the future of nursing: What it means for advancing nursing education. Mission Health Nursing Education and Research2.

Jellinek, P. S., Reinhardt, R. J., Ladden, M. D., & Salmon, M. E. (2015). Round six of partners investing in nursing’s future: Implications for the health sector, policy- makers, and foundations. Health Affairs, 34(7), 1245–1249. https://doi.org/10.1377/ hlthaff.2015.0144.

Johnson, P. (2014). The RIBN initiative: A new effort to increase the number of bacca- laureate nurses in North Carolina. North Carolina Medical Journal, 75(1), 39–44. https://doi.org/10.18043/ncm.75.1.39.

Johnson, P., Hall, V. P., & Causey, B. (2011). Regionally increasing baccalaureate-pre- pared nurses in North Carolina: The RIBN project. North Carolina Medical Journal, 72(4).

Knowlton, M. (2017). Student perceptions of stressors and the value of coaching in a baccalaureate nursing articulation program. Nursing Education Perspectives, 38(5), 277–278. https://doi.org/10.1097/01.NEP.0000000000000170.

Knowlton, M. C., & Angel, L. (2017). Lessons learned: Answering the call to increase the BSN workforce. Journal of Professional Nursing, 33(3), 184–193. https://doi.org/10. 1016/j.profnurs.2016.08.015.

Kumm, S., & Laverentz, D. (2019). A nursing partnership to accelerate academic pro- gression. Nursing Education Perspectives, 40(1), 53–54. https://doi.org/10.1097/01. NEP.0000000000000312.

Landen, J., Evans-Prior, D., Dakin, B., & Liesveld, J. (2017). Innovation in academic progression: Progress of the New Mexico nursing education consortium model. Nursing Education Perspectives, 38(5), 26–29. https://doi.org/10.1097/01.NEP. 0000000000000206.

Magnussen, L., Niederhauser, V., Ono, C. K., Johnson, N. K., Vogler, J., & Ceria-Ulep, C. D. (2013). Developing a statewide nursing consortium, island style. Journal of Nursing Education, 52(2), 77–84. https://doi.org/10.3928/01484834-20130114-01.

Masters, K. (2015). Implementation of a generic baccalaureate concurrent enrollment program: Increasing the percentage of nurses prepared at the baccalaureate level. Nursing Education Perspectives, 36(3), 192–193. https://doi.org/10.5480/13-1124.1.

Metcalfe, S. E., Lasher, R., Lefler, L. J., Langdon, S., Bell, R., & Hudson, D. (2017). Pipeline programs to increase the diversity of health professional students at Western Carolina University: Combining efforts to foster equality. Best Practices in Health Professions Diversity, 10(2), 7.

Metcalfe, S. E., & Neubrander, J. (2016). Social determinants and educational barriers to successful admission to nursing programs for minority and rural students. Journal of Professional Nursing, 32(5), 377–382. https://doi.org/10.1016/j.profnurs.2016.01. 010.

L. Angel Journal of Professional Nursing 36 (2020) 628–634

633

National Academy of Medicine (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

Pittman, P. M., Kurtzman, E. T., & Johnson, J. E. (2014). Academic progression models in nursing: Design decisions faced by administrators in four case studies. Journal of Nursing Education, 53(6), 329–335. https://doi.org/10.3928/01484834- 20140520-03.

Price, C. (2014). Your academic progression in nursing—No time like the present to start your plan!. Journal of Perianesthesia Nursing, 29(2), 161–163. https://doi.org/10. 1016/j.jopan.2014.01.005.

Reid, H., Tart, K., Tietze, M., Joseph, N. M., & Easley, C. (2017). Texas team: Academic progression and IOM toolkit. Nursing Education Perspectives, 38(5), 255–258. https:// doi.org/10.1097/01.NEP.0000000000000210.

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopaedic Nursing, 36(1), 12–25. https://doi.org/10.1097/NOR. 0000000000000308.

Schuler, M. E., (Polly) Johnson, M. P., Stallings, K. D., & Li, Y. (2017). Chief nursing

officer survey: BSN and higher degree initiatives in North Carolina. Nursing Education Perspectives, 38(5), E8–E12. https://doi.org/10.1097/01.NEP.0000000000000203.

Spetz, J. (2018). Projections of progress toward the 80% bachelor of science in nursing recommendation and strategies to accelerate change. Nursing Outlook, 66(4), 394–400. https://doi.org/10.1016/j.outlook.2018.04.012.

Sportsman, S., & Allen, P. (2011). Transitioning associate degree in nursing students to the bachelor of science in nursing and beyond: A mandate for academic partnerships. Journal of Professional Nursing, 27(6), e20–e27. https://doi.org/10.1016/j.profnurs. 2011.08.004.

Yambo, T. W. (2018). Academic progression in nursing education: Advancing seamless educational mobility. Nurse Educator, 43(2), 60–62. https://doi.org/10.1097/NNE. 0000000000000404.

Zittel, B. (2018). Passage of New York state legislation mandating academic progression toward the bachelor of science in nursing degree. Journal of Nursing Regulation, 9(2), 4–8. https://doi.org/10.1016/S2155-8256(18)30112-1.

L. Angel Journal of Professional Nursing 36 (2020) 628–634

634