April 1, 2015 Peg Daw- MHEC Oscar Ibarra-HSCRC Priscilla Moore-MHEC Nurse Support Program II Competitive Institutional Grants Technical Assistance Meeting April 1, 2015 Peg Daw- MHEC Oscar Ibarra-HSCRC Priscilla Moore-MHEC

Nurse Support Programs NSP I- Hospitals NSP II- Higher Education Website: www.nursesupport.org Health Services Cost Review Commission provides stable funding and oversight. HSCRC administers NSP I MHEC administers NSP II

Nurse Support Programs NSP- HSCRC began funding Nurses ~~1986 NSP I- On July 1, 2001, HSCRC approved hospital revenue for hospital-based initiatives aimed at addressing the short and long term nursing shortage impacting Maryland hospitals.  NSP II – On May 4, 2005, HSCRC approved hospital revenue for use in expanding the nursing workforce through increased nursing faculty and nursing program capacity in Maryland.

Goals of NSP I and NSP II NURSING FOCUS: Two Aims 1. Increase the number of registered nurses 2. Increase the number of nurse faculty

Funded Nursing Programs FY 2006- FY 2015 12 Universities 15 Community Colleges 27 SON $7.1 mil 3 $6.3mil 3 $2.3 mil 1 $44 mil 16 $3.8 mil 4 NSP II Competitive Institutional Grants Awarded ~ $63 mil

NSP II Program Evaluation Types of Program Initiatives (N=41) Community Colleges Private University Public University Historically Black College or University TOTALS Increase pre-licensure RN graduates 2102 180 175 150 2607 New RNs Increase graduate degrees-MSN, DNP   142 310 632 MSN/DNP Student Retention and Success 135 135 New RNs Increase RN to BSN completions 275 302 577 RN-BSNs Increase statewide resources, faculty, preceptors, simulation 474 177 154 805 Faculty/ Preceptors Total Graduates 2711 774 941 330 4756

Measurement and Evaluation 5800 or 27% total 20,967 pre-licensure graduates attributed to NSP II In 2013, 1,726 ADNs (58% increase) In 2006, 1,090 ADNs In 2013, 1,615 BSNs (43% increase) In 2006, 1,127 BSNs

Measurement and Evaluation No known impact on PhD graduates 2005- 87 PhDs 2013-88 PhDs 621 new MS and 203 new DNP degrees directly attributed to NSP II 219 % Increase in MS degrees from 2006 to 2013

INPUTS NSP II Evaluation Resources SITUATION OUTPUTS IMPACT New Faculty- new hires Project Directors Instructional supplies Funding- grant and In-kind Clinical Simulation External Consultants Professional development Instructional Technology Collaborations SITUATION Shortage estimates Associated hospital cost Faculty shortage Turned away students OUTPUTS New/Expanded Programs 5 + MSNs, 2+ DNPs 2+ BSN, 3+ RN-BSN Accelerated Programs 3 + ADN cohorts, 2 + WE Technology/ Development 4+ Simulation labs 5+ Online- 4+ Faculty Development IMPACT 27% of New RNs Renewed (5 yrs) $75 million 5 New Initiatives- Related to IOM Goals Evaluation & Dissemination OUTCOMES 2237 ADNs 621MSNs 505 BSNs 190 DNPs 577 RN-BSNs 245 NNFF 51 NEDG 296 GNF 805 Certificates

HRSA Workforce Evaluation   2012                                         2025 Projected State Supply & Demand Demand Supply Difference Maryland 60,600 72,000 59,900   -12,100 Virginia 69,900 87,300 106,700 +19,400 Pennsylvania 145,000 152,600 178,400 +25,800 Delaware 10,600 12,500 16,200 +3,700  West Virginia   20,600   21,100  29,000   +7,900 US 2,897,000 3,509,000 3,849,000  + 340,000 Source: HRSA (2014).The Future of the Nursing Workforce: National and State Level Projections, 2012-2025 Notes: Projections assume demand and supply are equal in 2012 and nurses remain in their state of training.

Nurse Support Program II Evaluation In 2014, at the conclusion of ten years of funding, the HSCRC and MHEC staff, with the help of a 7 member Advisory Group completed the program evaluation. Many stakeholders provided letters of support: 15 schools- MHA and MNA HSCRC renewed NSP II for 5 more years ~ $75 mil on 1/14/15 NSP II Workgroup provided guidance and new RFA released 3/13/15 Nurse Support Program II Evaluation http://www.hscrc.state.md.us/documents/commission-meeting/2015/01-14/HSCRC-Public-Pre-Commission-Meeting-2015-01-12.pdf

IOM Goals = NSP II Goals #4- Increase RNs to 80% BSN by 2020 #5- Double the # of RNs with Doctorates 2020 #6- Ensure lifelong learning for RNs #7- Enable RNs to lead change The Future of Nursing: Leading Change, Advancing Health (2010)

NSP II- New Goals & Metrics NSP II Workgroup Members: Dr. Steve Jencks- HSCRC Commissioner Advisory Group- NSP II Project Directors & NSP I Nurse Leaders Chief Nursing Officers at Hospitals Maryland Board of Nursing Maryland Hospital Association MNA, MONE, MDAC, MHEC, HSCRC

Workgroup Recommendations 5 New Competitive Institutional Grants Initiatives Pre-licensure RNs Advance education RN-BSN, MSN, Doctoral Doctoral- prepared RN Faculty Continuum of care- education/practice Statewide capacity

Workgroup Recommendations Baseline Data Evaluation Tools 2 New Statewide Initiatives Leadership Consortium Clinical Simulation Resource Consortium Dissemination Requirements

Initiative #1 Increase Nursing Pre-licensure enrollments and graduates Academic Progression-Dual Enrollment To meet IOM Goal #4, need community colleges nurse educators working alongside university and hospital nurse educators to prepare future RN workforce

Initiative #2 Advance the education of students and RNs to BSN , MSN and Doctoral level Programs approved by MHEC/MBON RN-BSN & RN-MSN (online-hybrid-onsite) MSN ( entry level, 2nd degree, MS) Doctorates (DNP or PhD) To meet IOM Goals #4, 5, 6 & 7

Initiative #3 Increase the number of doctoral prepared nursing faculty DNP, PhD Nursing Faculty Careers MBON and MHEC program approvals To meet IOM # 5, 6 & 7

Initiative #4 Build collaborations between education and practice that develop new models that promote a patient centered continuum of care Prepare RNs to lead change in hospitals Utilize NSP I and NSP II Academic/Practice Leadership Increase primary care- APRNs, NPs To meet IOM Goals # 4, 5, 6 & 7

Initiative #5 Increase educational capacity statewide Develop innovations Standardize Share Disseminate To meet IOM Goals # 4, 5, 6, & 7

Equivalents (Total FTEs) Data Tools- Faculty Mandatory Data Table for all Proposals and all Future Interim Annual and Final Reports FACULTY for current AY ( 2014-2015) Equivalents (Total FTEs)   FT PT Total Number Nursing faculty with PhD in Nursing Nursing Faculty with PhD - Other Nursing Faculty with DNP Nursing Faculty with EdD Nursing faculty with MSN Clinical nursing faculty with BSN Clinical nursing faculty with MS

Data Tools- Students Academic Year/Session for Indicated Program- Describe Program Type Program Capacity (new students only)   Number of qualified applicants Qualified but not admitted Admitted who registered Graduation Rate Retention Rate # Graduates per academic year (as appropriate) Graduates ADN BSN Master Entry   RN-BSN RN-MSN MS DNP PhD

Data Tools- Diversity Underrepresented Groups in Nursing Ethnic/Racial Minority   % White % Non-White Total Number Nursing faculty (Full Time) Clinical or part-time faculty Nursing students Underrepresented Groups in Nursing Gender   Female Male Total Number Nursing faculty (FT) Clinical or part-time faculty Nursing students

Data Tools- Geographic Can we answer the question: Where do our RNs ( students/Faculty) work and live? In-State or Out of State State of Residence   Maryland Geographic Neighbors (VA,DE, DC, PA, West VA) Other States Total Number Percent In State Nursing faculty (FT) Clinical or part-time faculty Nursing students

Findings- MONE Hospital Survey Maryland Hospital CNOs reported: Top 3 hard to fill departments: ED(71%), ICU(68%) and OR(58%) Most difficult to fill RN roles: RN Manager (63%), Director(50%), Educator(47) In 2015, 53% CNOs creating new RN jobs: Care navigator(64%), Documentation RN(64%), Care coordinator(50%), Quality/Safety RN(50%) Hospital Educator- Professional Development Specialist- often misnamed Clinical Nurse Specialist (8 titles)

NSP II Faculty Survey (n=389) 86% of 79 Faculty with Doctorates (PhD, DNP, EdD) are over age 54 (n=68) Younger Faculty- more diverse/less education/ less opportunity Preference for Doctorates/Experience 50% all Faculty retiring in 10 yrs. 70% all Faculty retiring in 15 yrs.

5 NSP II Nurse Faculty Resources Faculty Survey- 7/28-10/31/14 389 Respondents 245 NNFF Recruit/retain 88% retention 51 NEDG awards for Doctoral Completions Leadership Consortium Simulation Consortium Hal and Jo Cohen GNF

Implications No research has been identified that provides a direct or indirect relationship between a state’s investment in Nursing faculty or nurses and the cost or outcomes of the state’s health care system……. Without a strategic framework, model of change and outcomes criteria…………. one solution will appear to be as good as any other ………. Kowalski & Kelley (2013)

NSP II Return on Investment Research is needed: Evidence based faculty strategies Innovative education initiatives ROI to fund nurse faculty & workforce Nurse’s impact on patient outcomes/cost NSP II funded programs need to be evaluated and disseminated through peer-reviewed publications. REQUIRED: Data Tables ( see pg. 6 & 18) Dissemination meetings ( see pg. 18 & 20)

NSP II Expectations Rigorous Reporting & Accountability Embed Retention, Simulation & IPE Collaboration among Project Directors Curricular Change/ Agreements Seamless Academic Progression Well Executed Programs/Innovations Hospital Leaders and Education Leaders Program Evaluation and Improvements

NSP II Evaluation 2019 Measure Progress and Impact NSP I and NSP II Goals for RNs INCLUDE: 1. Statewide strategies for the workforce 2. Right RN skills/mix =Triple Aim/Waiver Next NSP II Evaluation Due 2019

References Institute of Medicine, (IOM) 2010 report, The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. Kowalski, K. & Kelley, B.M. (2013). What’s the ROI for resolving the nursing faculty shortage? Nursing Economics, 32(2), 70-76. Nurse Support Program II. Accessed at www.nursesupport.org Nurse Support Program II Faculty Survey, completed October 31, 2014, released at NSP II Advisory Group meeting on November 19, 2014.

References Nurse Support Program II (NSP II) Outcomes Evaluation FY 2006- FY 2015 and Recommendations for Future Funding http://www.hscrc.state.md.us/documents/commission-meeting/2015/01-14/HSCRC-Public-Pre-Commission-Meeting-2015-01-12.pdf

Addendum During the NSP II Technical Assistance Meeting, many questions arose. The program is essentially the same; however, many participants had specific questions about the new data requirements and items that might be allowed. Afterwards, some who did not attend requested more assistance, so the following Q & A Session slides were developed!

Q & A Session Can we write more than one grant proposal? Can we write a grant for more than 1 initiative? No, please address one major initiative per proposal. Yes, there is no limit on the number of good proposals that a school can submit.

Q & A Session Can we ask for funding for pre-nursing students? Can we write grants for equipment? Can we ask for funding for pre-nursing students? Probably not, we did not have any of these discussions in the Workgroup and are not familiar with how to measure actual RN graduates within a grant’s time frame. No, there is an option for instructional technology, but it is not the main focus/funding of a proposal that measures progress in nurse graduates.

Q & A Session Do we have to complete the enrollments listed on pg 16? Is the Cover sheet and data tables part of our 15 page limit? Yes, that is background information- include in the narrative a snapshot of the program’s enrollments- in addition to the required data set. No- they are not counted in your narrative section. Please number all pages!

Q & A Session What are Dissemination Activities? Do we have to include funds for faculty to attend the Maryland Action Coalition meetings? Yes- the MDAC is our lead organization reporting on movement towards IOM Nursing Goals. Conferences, meetings, & activities to share best practices and progress on successful programs on IOM Goals – national, state, local- for Maryland’s RNs.

Q & A Session Where do I find the data required? How did you decide on these data? The Workgroup consulted with Deans/Directors of Nursing Programs. Consult with yours. Deans and Directors/ Nursing Programs report standard, readily available data to the MBON and Accreditation Boards. These data are defined and consistent.

Q & A Session What is the deadline for the electronic files? Do we have to submit the hard copies by 4/24? The Deadline for submission is 4/24. All items- electronic proposals and excel budget with hard copies are due in MHEC’s offices- 10th Floor. Yes The Receptionist leaves at 4pm, therefore, proposal packages can be hand delivered up until that time.

Q & A Session What are Statewide Initiatives? Can schools apply for the Statewide programs? Faculty Focused Funded Programs Not part of the Competitive Institutional Grants Listed for information No- these are faculty focused initiatives guided by a Nursing Dean/ Director nomination process- available to faculty in nursing programs.

Q & A Session Can hospitals apply for NSP II? Why did the Workgroup emphasize Hospitals and Higher Education collaboratives? No Hospitals have NSP I funds. However, nursing schools and hospitals are encouraged to partner and share NSP I and NSP II Funded programs/ initiatives. It is a natural fit- they share the same end goals- a highly educated RN workforce that meets the needs of Maryland’s Waiver & the Triple Aim- better care & better health/ patient experience at lower cost.

Q & A Session What about Nurse Residency Programs? What about the NSP II Simulation and Leadership Consortiums? Nurse Residency could be considered as an aspect of an NSP II Education Focused program, i.e.: Academic credits for Residency Courses Hospital Nurses/ Leaders are eligible, as well as Nurse Faculty. The CNO or designee can nominate participating hospital RNs/ educators and Deans/Directors can nominate faculty.

Q & A Session What is the abstract? What if we need to have more pages to explain our proposal and funds request? The panel may have 27 proposals to review. They are RNs or hospital professionals and well informed. Please make sure you deliver a clear, concise proposal. Answer anything a potential reviewer would question. State the case in the first 1-2 pages- then build it. Use addendum for job descriptions, etc. A well written abstract – 1-2 paragraphs- less than 200 words. It briefly describes the program- may be included verbatim in future outlines/ or on the www.nursesupport.org

Q & A Session Electronic copies- PDF signed budget- with narratives What about the budget pages? How do I deliver the budget? The budget needs to be completed on a single budget sheet for each year. In addition, all years of the grant proposed should be submitted in Excel. Electronic copies- PDF signed budget- with narratives Excel format by email Priscilla.Moore@maryland.gov Send signed hard copy with copies of proposal

Q & A Session What about the Evaluation Plan? HSCRC and MHEC expect the evaluation to be clear, well considered and easy to follow. Recommended: prepare a Logic Model for your program proposal. Sample templates at http://www.uwex.edu/ces/pdande/evaluation/evallogicmodelworksheets.html

NEW Mandatory Requirements Data Tables Page 7, 8 & 9 Appendix A behind Cover Sheet Format & Data required Dissemination Activities Part of the Evaluation Plan Funded in the Budget Activities reported within Annual and Final Reports

Location of MHEC Offices Maryland Higher Education Commission 6 N. Liberty St., 10th Floor Baltimore, Maryland 21201 Located in MSDE/ Nancy Grasmick Building Across from the First Mariner’s -on the corner of W. Baltimore and Liberty St. Questions: Contact Priscilla Moore at 410-767-3099 or email at Priscilla.Moore@maryland.gov