Nursing is unique among health care professions in offering multiple levels of education for entry into practice: a diploma, an associate degree (ADN), or a bachelor's degree in nursing (BSN). The call for a single entry level into practice dates back to 1960s when the American Nurses Association (1965) released a position statement on minimum preparation for entry to practice as the baccalaureate degree. The Institute of Medicine (IOM, 2011) directed that nursing education develop systems that promote seamless academic progression.

To progress toward the IOM education goal, innovative programs have been developed to facilitate the education of nurses at a higher level to meet health care demands (Gorski, Farmer, Sroczynski, Close, & Wortock, 2015; National Academies of Sciences, Engineering, and Medicine, 2015). This article describes the process of developing an innovative academic progression model that partners a university with community colleges to provide students the opportunity for concurrent enrollment and simultaneous completion of the ADN and BSN degrees.

INITIAL STEPS

Development of the University-Community College Nursing Partnership model (referred to as the Partnership) started in May 2013 when deans and directors of the 17 public ADN programs in the state had the opportunity to hear Dr. Jean Giddens explain concept-based education and the New Mexico Nursing Education Consortium model (Landen, Evans-Prior, Dakin, & Liesveld, 2017). The deans and directors discussed this state's problem - that ADN students were being excluded from many hospitals for clinical experiences and graduates were not being hired in Magnet(R) or Magnet-seeking hospitals. This prompted exploration of the formation of a nursing partnership.

Many phone conversations and web-based meetings took place after the May meeting. In October, the deans and directors convened to form a partnership to provide a concurrent curriculum. Results of these meetings included several major decisions:

* ADN programs would individually decide if they wished to participate in the Partnership. Five ADN programs and the university formed the initial partnership, with the option for other programs to join later.

* Based on availability of clinical sites, each ADN program would schedule courses as needed.

* The university would offer courses similar to RN to BSN courses.

* The university would inform other Board of Regents BSN programs and ask them to join the Partnership.

The Partnership received approval by the Board of Regents and State Board of Nursing in spring 2014. A pilot cohort was admitted in January 2015, and two students graduated in May 2016.

THE PARTNERSHIP MODEL

The Partnership model requires two additional years after the students complete all BSN prerequisites. Students take ADN and BSN courses simultaneously, and after completing both programs, they graduate with both degrees and take the national licensure examination.

Students are informed of the Partnership when they notify the community college of their interest in nursing. Students who wish to be considered for the Partnership complete all BSN prerequisites (60 credit hours) and then apply to the ADN nursing program. After acceptance into the ADN program at the community college, students apply to the BSN program. Academic advisors at the community colleges are gatekeepers, encouraging eligible students to apply. Partnership students take the same nursing courses as the other students in the ADN program, but instead of taking general education courses, they simultaneously take baccalaureate courses. The ADN courses are provided in face-to-face and hybrid classes, whereas the BSN courses are provided online.

The community college determines the order and content of the ADN courses. The university requires 30 credit hours for graduation, which are delivered in 10 three-credit courses. Partnership students take two BSN courses in each of four semesters and one summer session.

OVERCOMING BARRIERS

With the decision to move forward with the Partnership, several barriers were identified. The university required the last 30 credit hours to be obtained through the university to establish residency. Other major barriers included accreditation by two different agencies (Accreditation Commission for Education in Nursing and Commission on Collegiate Nursing), financial aid for students in dual programs, State Board of Nursing approval, approval from college and university presidents, and approval from each program's curriculum committee. Taskforces were developed to look at specific issues and overcome barriers.

Some barriers were easy to resolve. For example, changing the requirement to 30 credits required for graduation (instead of the last 30 hours) had already been approved for other university programs and required less effort than expected. Financial aid and accreditation took longer. Because students were not full-time students in the ADN or BSN programs, a consortium was formed to allow for financial aid. Agreement was reached that the university would be the home school for financial aid.

For accreditation, each nursing program submitted a substantial change notification to its respective accrediting body. Several ADN programs were in the process of reaccreditation and elected to wait until they were reaccredited before enrolling students in the Partnership model.

One ADN program and the university began a pilot program in fall 2015 with six students, two of whom were in their second semester. The second-semester students completed the 10 university courses in three semesters and a summer session and graduated successful in May 2016. However, both ADN and BSN faculty decided that this was not a desirable schedule and determined that students should only enter the program during their first semester of nursing school.

In addition to general policies on admission and progression, specific policies were developed for students who do not successfully complete a course and students who withdraw from the Partnership but complete the ADN. Students who are not successful in one course (ADN or BSN) may repeat the course and then join the succeeding cohort. Students who are not successful in two courses are dismissed from the program.

Students may withdraw from the Partnership and complete the ADN program. Successfully completed BSN Partnership courses will be accepted as equivalent for counterpart courses in the RN to BSN program.

BENEFITS AND OUTCOMES

Several benefits have been identified for the Partnership, including the following:

* Decreased cost. The Partnership is less expensive for students than attending university for four years or obtaining an ADN and then enrolling in an RN to BSN program.

* Location. Partnership students are not required to move and are more likely to stay in the local community, increasing the number of BSN-prepared nurses in rural areas.

* Increased diversity. Students in ADN programs in the state represent greater diversity than do students who attend the university.

The number of students enrolled in the Partnership model continues to increase but, as with other prelicensure programs, attrition occurs. Some students discover that nursing does not meet the image they had from the media, and some students choose another field. Several students have had to repeat courses and join the succeeding cohort.

IMPLICATIONS FOR NURSING EDUCATION

The Partnership model provides an additional option for seamless academic progression that could be replicated in other states. To develop such a model, the university and ADN program faculty must work collaboratively to avoid redundancy of curricular content. Then the BSN program needs to determine what should be included in the curriculum to complete BSN outcomes.

This model addresses barriers identified in the literature for completion of the BSN degree. Students enrolled in the Partnership graduate with ADN and BSN degrees at the same time, eliminating additional years of education and enabling students to remain in their hometowns to complete the university degree, thus decreasing costs and increasing the population of baccalaureate-prepared nurses in rural areas. Curriculum reform is necessary to address the barriers to seamless academic progression in nursing, to meet the IOM goals to achieve an 80 percent RN workforce educated at the BSN level or higher, and to meet health care demands, now and in the future.

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