Ivy Leaf - Spring 2009

Where There is a Need, There is a Way

Building a Sustainable Healthcare Community in Rural Pennsylvania

By Sherry Sullivan

In many cases, when asked to write this kind of article, I start with a look at my own life experiences. What do I know about this topic? How could or does it impact me? So, this article will begin with a small story about my grandmother.

Born in Chile, South America, she came to the United States with her American-born parents, soon to become one of four children of a single parent. She graduated from high school, but never earned a college degree. She married, had four children of her own, and turned what some might consider a normal, average life into one of incredible service.

For many summers, I visited my grandmother in dry, hot Oklahoma. And, on those visits, I would ride with her in her old, red Datsun station wagon as she would visit the poor (and often sick) elderly to deliver meals. You see, my grandmother started the Meals on Wheels program in Oklahoma City in 1979. And at age 85— thirty years later—she was still involved. Over those thirty years, she had taken her children, grandchildren, and even a few great-grandchildren on those visits. She was a caregiver who saw a need. And it all started with a grant.

So when I was asked to write about the Accelerated Bachelor of Science Nursing Program (ABS) at Penn State, I was reminded of the incredible needs—often unaddressed—that exist in our own backyards. This backyard—the Commonwealth of Pennsylvania—ranks second nationally in the percentage of population over sixty-five (15.2 percent). It ranks third nationally in the number of rural elders—the fastest-growing segment of the population, projected to increase by 27 percent over the next twenty years.

Combine the escalating needs of this growing rural elderly population with a shortage of baccalaureate-prepared registered nurses, and the future— for many—could present significant challenges.

A clear understanding of these challenges fueled Dr. Raymonde Brown and colleagues to address the issue. Brown, associate dean for Undergraduate Programs and Outreach at Penn State’s School of Nursing, led the way as the director for a three-year, $841,514 grant from the U.S. Health Resources and Services Administration—a grant offering RNs the opportunity and resources to earn a bachelor of science degree in Nursing within twelve months.

With a BS-prepared nurse, we have seen higher levels of care quality and lower levels of mortality.

"This initiative really was driven by the national nursing shortage overall," Brown explained, "as well as the mismatch in the educational mix within the shortage. Studies have documented the impact across the composition of the nursing workforce. People assume that a nurse is a nurse is a nurse. However, with a BS-prepared nurse, we have seen higher levels of care quality and lower levels of mortality. This is not to say that other levels of nursing should be eliminated. We are looking for the best mix to provide the best quality of care."

Building on the foundation of Healthy People 2010, "a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats," Brown focused in on Healthy People’s two primary goals: (1) to increase quality and years of healthy life and (2) to eliminate health disparities. Across the Pennsylvania landscape, the opportunity appeared to bring together a rural RN workforce with an innovative educational advancement program in order to begin to fulfill those objectives.

The ABS Nursing Program was launched at two Penn State campuses in fall 2008: Penn State Altoona and Penn State Fayette. The goal, during the three-year project, is to recruit 100 RN-to-BS candidates, to graduate 100 RN-to-BS candidates, and to sustain the program as well as expand it to campuses with nursing programs across Pennsylvania.

Dr. Suzanne Kuhn, senior instructor in nursing and project coordinator at the Altoona campus, is excited about the enthusiasm she has seen for the program. "We have a nine-member RN cohort group at Altoona who will graduate in August this year after completing the three-semester plan," she said. "This grant is really focused on meeting the needs of RNs who are balancing other commitments and, in a rural community like Altoona or Fayette, there are a lot of them who face challenges in balancing commitments in a traditional program. Very quickly, we were able to attract nine students into the program."

The cornerstone of the ABS curriculum "is providing a quality BS completion program in a format that is efficient," thus benefitting the local nursing workforce as well as the communities overall. Within Pennsylvania’s rural communities—forty-eight of the Commonwealth’s sixty-seven counties (including Fayette and Altoona) according to the 2000 Census—RNs with associates degrees or diplomas face obstacles in completing a baccalaureate degree through traditional means. However, the Penn State ABS Nursing Program requires a student commitment of only one day or its equivalent per week for in-class time. The compressed curriculum is provided through a mix of classroom, Web-enhanced and Web-delivered formats, thus meeting the needs of RNs who are already balancing existing work and family obligations that cannot be compromised for a degree. Other critical resources are provided including mentoring staff, computer support, tutoring, and writing center services as well as online and onsite project staff and faculty. Additionally, clinical requirements can be coordinated with partnering clinical institutions and community services and agencies, thus accommodating locationbound students.

One of those location-bound students is Laurie Walker. Originally from Orbisonia, Pennsylvania, Walker attended Central Pennsylvania College in Summerdale to obtain her certificate in medical assisting. "I always wanted to be an RN," she explained, "but when you are eighteen, sometimes you make quick decisions. Within the first three years after my degree, I started feeling like there was something I hadn’t finished."

In August of 2002, Walker was admitted to the Penn State Altoona associate degree RN program. "Again," she described, "I just wanted to get my degree and move on. But I still had that feeling like my work really wasn’t finished – like I had something hanging over my head."

The reality is that I do work full time, I have a family, and I live almost an hour away from Altoona. I could not have gone back to school if it wasn’t for this program.

Joining the nursing staff at Lewistown Hospital as an RN, Walker soon became a wife and a mother. Now living in McVeytown, Pennsylvania, access to a backto- school environment was very limiting. "I have often heard the discussion about whether entry into nursing should be just an associate degree or a bachelor’s degree. Last year, I called Dr. Kuhn at Penn State Altoona to talk to her about my options. She told me that they were working on this funding, and by the time I started back in August 2008, it had come through."

And the timing could not be better. As reported on Forbes.com on February 6, 2009, layoffs for the month of January 2009 reached 163,662 for America’s largest 500 companies. While this doesn’t necessarily capture the picture of job losses at regional and local organizations, it does clearly illustrate the impact of the current economic downturn. Thus, while many industries have been hurt by recessionary trends, Brown and the Penn State School of Nursing have found a way to provide opportunities to RNs and families at a very critical time.

"This really has been a blessing in disguise," Walker said. "My husband was laid off in November. I will be finished this fall and will be able to look for opportunities where I can increase my pay. At the same time, I have more opportunities for flexibility. I would really like to consider a position in nursing management or possibly even a school nurse once my daughter is in school."

"The reality is that I do work full time, I have a family, and I live almost an hour away from Altoona. I could not have gone back to school if it wasn’t for this program. Today was the end of the first seven-week class of this semester. This is definitely a fasttrack program, but it feels so good to see the progress I am making. I have a friend who is in an RN-to-BS program at another school. She is taking fewer classes, but they cover full, traditional semesters. It is taking her a lot longer to finish her degree."

And, as the program continues to be a success for students like Laurie Walker, Penn State Altoona may find itself leading the way in this industry trend.

"When I look at what is being offered to RNs around the country," Brown observed, "I see that our program is one of the few nationwide that is twelve months. Many are at least two years. Students draw this out even longer in order to meet work and family responsibilities. Here, they are done in one year. Our students represent an existing workforce that needs a B.S. in order to advance their careers. I would love to see this expand into other campuses across the Commonwealth."

My grandmother passed away last month. I had just arrived in Hong Kong when I learned of her death. Because of my travels, I was unable to return in time for her memorial service, so I made one of my own. In it, I looked back on the life of one who took from her own set of circumstances to make life more comfortable, meaningful, and life-filled for others. But I was saddened—saddened because I was left wondering who might be the one to take her place. This assignment came just in time to set my mind at rest. There are those who seek to serve their own communities—to add quality and years of healthy life. And now they have a chance.