May 18 - 20, 2005
ITEM 127-105-R0505 Guidelines for Licensed Practical Nursing Programs
THAT: The Board of Regents of Higher Education approves the following program model for Licensed Practical Nursing programs in the Montana University System and the three (3) community colleges:
(1) the credential awarded to students who complete a licensed practical nursing program will be a certificate;
(2) all of the licensed practical nursing programs will be 50 credits;
(3) all of the licensed practical nursing programs will include a common set of pre-nursing courses, totaling 24 credits;
(4) all of the licensed practical nursing programs will include a common set of nursing courses, totaling 24 credits plus a 2-credit “scope of practice course.”
Table 1, attached to this item, describes the pre-nursing and nursing courses in more detail. It also includes the coursework for those programs that offer both an LPN and a two-year RN credential.
EXPLANATION: This action item is proposed in response to Recommendation 6 of the Legislative Audit report concerning transfer of credit practices in the Montana University System. In addition, the Board of Regents authorized a similar project, in May 2004, based on a recommendation of the Nursing Coordinating Group and the work that that Group had done on nursing issues for almost a year.
The discussions that led up to this proposal were extremely difficult, primarily because nursing education takes many different forms in Montana. The Montana University System and its community college colleagues currently have:
· two (2) recently-approved LPN/RN programs, in Missoula and Helena, that operate a bit like the proposed model, but not quite; those programs are so new that the first RN students haven’t even been admitted to the programs yet;
· one (1) associate degree RN program in Butte; that nursing program also offers an LPN certificate that is more separated and self-contained than the proposed model;
· two (2) stand-alone LPN programs in Great Falls and Billings;
· two (2) stand-alone associate degree RN programs in Havre and Miles City; and
· one (1) stand-alone baccalaureate RN program in Bozeman.
In creating a one-size-fits-all model, the LPN work group had to struggle with the needs of LPN/RN programs that are quite integrated; the independence of LPN programs that focus exclusively on that kind of nursing education; and the insulation of RN programs that have nothing to do with LPN education, except when those nursing professionals decide that they want to add to their credential.
The model that was finally adopted by the nursing work group, to satisfy the mandates of the Legislative Audit Committee and the Board of Regents, is utilized by at least 22 other states. It includes (a) pre-nursing coursework that is appropriate for both the LPN and RN credential; (b) an initial year of nursing courses, with a so-called exit point or stop-out for programs that offer both credentials; students can sit for the LPN licensure examination at that stop-out point; and (c) an additional year of nursing coursework, for students who want to continue their education, after which they can take the RN licensure examination.
The model has several important advantages:
(1) it has been used in many other states. Table 2, attached to this item, sets out LPN and RN educational models across the United States. Many of them use an integrated LPN/RN model, with an LPN exit.
(2) it elevates the educational expectations for LPN nurses, which will hopefully lead to a more qualified, professional nursing cadre in the State.
(3) that elevation coincides with a health care industry that expects more and more skills from licensed practical nurses, a revision of the licensure test for LPN nurses that reflects those more sophisticated skills, and a Montana State Board of Nursing project to review. . .and probably expand. . .the scope of practice for LPN nurses in the State.
(4) in the opinion of most members of the work group, the best way to achieve an integrated LPN/RN nursing program, which is the expectation at three campuses, and the best way to insure transferability between LPN and RN programs, is to adopt this model with the LPN exit point.
(5) it satisfies the expectations of the transfer audit, and the project endorsed by the Montana Board of Regents.
(6) because of the common pre-nursing and nursing coursework, students should be able to transfer between LPN programs without losing credit for the work they have done at some other institution. They should also be able to move into RN programs throughout the System. Resources will continue to limit that movement between programs, however, since all LPN and RN programs in the State have limited enrollment policies that can only be expanded by the addition of more nursing faculty and the availability of appropriate clinical settings.
(7) currently, the number of credits required in most of the LPN programs in Montana is close to the 72-credit total required for a two-year RN degree. Four of the five LPN programs in Montana require between 65 – 70 credits to complete the credential. Only Montana Tech, which has the most experience delivering both LPN and RN education, has a credit total that is similar to this proposed model. I.E., 45 credits.
(8) no one in the work group was able to come up with an acceptable alternative. The work group was made up of all of the LPN and RN nursing administrators in the MUS System, the community colleges and one tribal college; some nursing faculty members; and representatives and staff from the State Board of Nursing.
As you would expect, the model also has several important disadvantages because of the “one size fits all” approach:
(1) because of the elevated educational expectations, completion rates for LPN students could well decrease. LPN and RN students will take the same pre-nursing coursework for their programs, and the content in the first year of nursing courses will also be the same for both credentials. RN students will obviously have to complete additional pre-nursing and nursing classes.
(2) the supply of LPN nurses could decrease. In the three integrated nursing programs, most nursing students will almost certainly not decide to end their education at the end of the second year. They will try to continue on for one more year to complete the RN credential, if they can afford it and the program has room. That is a logical expectation, and it certainly describes the experience of the nursing program at Montana Tech of The University of Montana, which has offered both credentials for several years. That inevitability was already put in motion, when the Montana Board of Regents approved two more nursing programs, in Missoula and Helena, that are similar to the Butte program. But this proposal will almost certainly encourage LPN graduates from the stand-alone programs in Great Falls and Billings to go on for the RN degree, if they can get into a program.
(3) The proposal does reduce the number of clinical hours in the LPN programs, which means that graduates will have less time to perfect their nursing skills. That reduction is directly related to the fact that the total credits required to earn an LPN certificate is reduced by 17 – 22 credits in this model.
(4) The proposal does change the stand-alone LPN programs. They will award a certificate in LPN nursing, and they will continue to promote themselves as LPN programs. But the coursework they provide will be significantly elevated, as far as content and skills are concerned, because it is essentially the same as the first year of nursing classes in two-year RN programs.
(5) Even though the work group included members of the State Board of Nursing, because of the way that Board operates, it will not give its official imprimatur to this proposal until a nursing program actually comes forward with the curriculum. Deputy Commissioner Barber met with the State Board of Nursing in late April to discuss the proposal and resolve issues of concern. But that conversation is not an official endorsement of the program.
(6) It will be difficult for a student to complete the integrated RN program in two years, under this model. But that is currently true of existing two-year RN programs, both in Montana and across the country. Those programs typically have 72 credits, which require a student to complete 18 credits a semester to graduate in two (2) years. Nursing courses, and their prerequisites, also build on each other, so the order of courses is not flexible and students cannot “just take more courses each semester.” In addition, because of the rigor and clinical hours in existing nursing programs, most students take three years to complete an RN program.
(7) The proposed model may result in additional costs for most institutions that offer LPN education. The costs could come inthe form of new classes, additional faculty or faculty with different educational credentials.
Transfer between LPN programs, and between LPN and RN programs, should be significantly enhanced under this proposal, primarily because of the commonality in credits, courses and course content. The most significant barrier to transferability will be program size, especially with the RN programs. All of those programs currently limit enrollment, because of faculty resource constraints and the availability of appropriate clinical settings in healthcare facilities. LPN graduates may not be able to continue their nursing education, if they cannot find an available “slot” in an RN program. That access issue will be exacerbated, if students are place-bound. New LPN nurses will also have to compete with practicing LPN professionals for those available RN slots, since the programs are committed to assisting all LPN nurses in their educational and professional goals.
Implementation of this academic program model will take some time:
· the Montana Board of Regents will have to approve the model;
· LPN programs throughout the State will have to revise their curriculum, based on the model; and those revisions will have to work their way through the internal review and approval process for academic programs on each campus. Several programs will also have to develop new courses, particularly in the area of pre-nursing coursework, and may have to find faculty to teach those classes.
· the State Board of Nursing will have to approve each individual program;
· the LPN programs will also have to develop completion pathways for students who are caught midway through the program when the new model is implemented;
· the programs will also have to develop alternative pathways for nurses who completed their LPN credential before this model was adopted.
The nursing faculty throughout the Montana University System and the community colleges have begun working on some of these implementation steps, in anticipation of the Board’s review and approval. Table 3, attached to this item, sets out the implementation schedule for the LPN programs in the Montana University System.