Abstract
For more than 7 years, 10 schools of nursing in Ontario have collaborated to prepare primary healthcare nurse practitioners. The authors discuss the establishment of the consortium and its benefits and drawbacks.
The need for specialty programs for small numbers of geographically scattered learners and the realities of shrinking financial resources and limited expertise require new approaches to offering educational programs. Working together to extend program accessibility is efficient and effective. Learners can access a broader range of expertise than would be possible if all potential providers duplicated efforts. Sharing through the use of distance education-with local arrangements for activities like clinical practice-benefits learners, faculty, and institutions.
While collaboration among providers is logical, maintaining collaborative programs over time can be daunting. Differences in institutional values and culture, rivalry among institutions, concerns about maintaining program quality, differences of faculty approach and philosophy, lack of regular direct contact among staff, and lack of financial advantage to participating institutions may lead to failures in collaboration. The time required to maintain collaboration may be a disincentive. For contentious issues, long hours of discussions may be required for resolution.
The primary healthcare nurse practitioner (PHCNP) program in Ontario is a successful collaboration that has been preparing nurse practitioners (NPs) for more than 7 years. Initiated and funded by the provincial government ministry responsible for health, the program is offered by a consortium of the 10 university schools of nursing in the province.
In late 1993, 10 years after withdrawal of government funding and closure of NP programs in the province, the Minister of Health announced that the government would support resumption of NP education. NPs were identified as important participants in primary healthcare reform. 1 The College of Nurses of Ontario, the registering body in the province, was promised legislation creating Extended Class registration for primary healthcare NPs. 2 This legislation was eventually passed and implemented in early 1998. In June 1994, the 10 deans and directors composing the Council of Ontario University Programs in Nursing (COUPN), an affiliate of the Council of Ontario Universities (COU), decided not to compete for the program and instead established a consortium to develop and deliver one program throughout the province by distance education.
No one university could easily prepare the new program. 3 Very few university nursing faculty had the necessary NP background and skills. Across the province, limited numbers of NPs were still in practice. 1 They were graduates of the earlier NP program or had been prepared in the United States. The NPs worked mainly under medical directives in community health centers or in isolated areas in the north. By combining resources in a consortium, there was enough expertise to mount a credible educational program to prepare NPs for primary healthcare. Access could be provided for nurses across the province, including those in remote areas. Collaboration also facilitated making the program available the two official languages of Canada; the French-speaking population in the province could be served by the two bilingual institutions in the consortium. French- and English-speaking experts could collaborate to speed development and ensure equivalent programs.
By September 1995, the government-ordained program start date, the consortium had to devise a common curriculum, identify and staff an organizational structure, set admission criteria, identify professors with appropriate expertise and interest, establish an infrastructure for distance education, and obtain program approval from the academic policy bodies of the 10 universities. 3 A unique organization that combined centralization and decentralization was developed and has evolved over time.
The model of inter-institutional cooperation is closest to what Lang 4 describes as a consortium, but there are differences from the usual characteristics he identifies, mainly because COUPN and the program are not incorporated as legal entities. While the program is separate from each of the members, functions that require legal status are distributed among the universities. Staff and faculty are hired for the program by particular universities. The government funding is sent to the program via the COU (it is incorporated) and then redistributed. There is one curriculum across the province, with common courses and common standards, but it has been approved separately by the academic governing committees of each university. The deans and directors of the 10 universities serve as a board of directors and make policy decisions. The curriculum was initially created by a committee composed of NPs, faculty familiar with curriculum development, and representatives of nursing organizations. Curriculum is now monitored, maintained, and revised by a central committee with membership from across the consortium.
Lead universities were established to house coordinators and manage the funding distribution for each of 3 geographic regions and the French language program. They were selected on the basis of location, and ability to house the coordinators, and provide resources required. Four coordinators were hired to implement and manage the program. Each of the 3 regions has a coordinator for the English language program, and the French language program coordinator works in the Eastern region lead university. 5 The coordinators are responsible for managing the program in their regions. They handle the funds, recommend faculty, hire tutors, identify clinical placements and local preceptors, and work with faculty liaisons. Each coordinator has a specialized task for the whole consortium. These functions include managing a common admissions process, maintaining a centralized data registry, working with the curriculum committee, or organizing distance education and technical support. The consortium realized early in the development of the program that in order to meet local needs, the non-lead universities needed faculty liaison positions. 5 These faculty members provide student counseling, lead the local admissions process, work with tutors and preceptors, and arrange local placements.
Students apply to and are registered at one of the 10 universities. The admission standards are the same at all the universities, but the students pay tuition and are subject to the academic regulations of their home university. A central data register is also required so that professors know who is in their class, and progress through the program can be tracked.
Unlike the majority of government grants to universities, funding for the program does not go into the general revenue of the participating universities, but is budgeted across the consortium. Faculty release time, part-time salaries, travel for coordinators, faculty and advisors, development, and distance education support costs are reimbursed via the coordinators and lead universities on the basis of costs incurred.
The government had decreed that the program should be a 1-year, post-baccalaureate certificate. The deans and directors would have preferred the program be at the Master's level, based on US experience. However, the government was only willing to fund a certificate program. The deans and directors bowed to political reality because they wanted to control the program as it developed.
The government also mandated that it must be possible for diploma-prepared nurses to take both baccalaureate degree completion and the PHCNP program in 2 calendar years of full-time study. Depending on whether they had an RN-BSN program and the organization of the curriculum, meeting this requirement was easier for some schools than others, and some have not participated in the integrated program. Most of the universities that offer this program incorporate the five NP-certificate courses provided by the consortium into the degree completion curriculum, usually as the final courses. Taking the integrated program requires more credits than the baccalaureate alone, but fewer than completing the degree and certificate separately. Graduates receive both a baccalaureate degree and the NP certificate required to write the extended class examination.
A process of prior learning assessment and recognition (PLAR) was required by the government, allowing NPs already in practice to challenge all or part of the program. 6 The consortium developed province-wide criteria and a process to assess portfolios submitted by NPs who sought credit in the program.