Where Did They Go In the First Place?

I have observed as many different life stories as there are students in our nursing refresher course. Many nurses had left clinical nursing behind as they turned their energies and attention toward raising their families; most with the intent to return to clinical nursing some day. As their families grew and their lives changed, many let go of the idea of ever returning to the clinical setting. Others had left looking for a different work environment. The fast paced, managed care driven, and often challenging environment found in most of the inpatient and outpatient settings today, had become unmanageable for these nurses. They looked for greener pastures. What some found were other healthcare related industries that could use their skills and knowledge. These employment opportunities range from healthcare administration, to education, to pharmaceutical and medical equipment sales, to case review for a managed care corporation. Finally, others had felt the need to change to a different industry all together, with many looking to the once attractive and profitable high tech industry. Whatever their reasons for leaving clinical practice, some do return, and most look for support in completing the transition.

What Does the Nursing Board Have to Say?

Currently, the Texas Board of Nurse Examiners (BNE) recommends that all nurses that have not been employed in “professional nursing practice” for more than four years take a nursing “refresher” course. This course can be a hospital-based extended orientation or a specific refresher course delivered by either a private agency or an institution of higher education. The BNE ensures that any nursing refresher include the following key components: the role of the nurse; a review of the nursing process to include assessment, planning, implementation and evaluation; a pharmacology review; a medication administration review; documentation, quality assurance and legal implications for nursing practice; current CPR certification; and a RN supervised clinical experience providing direct patient care (Texas Board of Nurse Examiners, 2002). Since this content is a review of basic nursing skills, continuing education credit is not awarded.

The status of the nurse’s license can make a difference in whether this recommendation becomes a requirement. For the nurse that has maintained his or her nursing license in good standing while they have been away from the clinical setting, it is left up to the potential employer to “enforce” the Board’s recommendation for a refresher course. Many hospitals will refer potential employees to their local refresher course provider, prior to hiring the returning nurse. For those nurses whose license is no longer active, often the Board will require a refresher course as one of the conditions for reinstating their license. This group of nurses may include: nurses that had their license suspended due to some corrective action by the Board, that has now been satisfied; nurses who for a variety of reasons let their licenses lapse; and those nurses licensed outside of the state of Texas that are in process of applying for their first Texas nursing license, and who have not practiced professional nursing during the last four years. Some nurses wanting to return to the clinical setting after being away for less than four years, still choose to take a refresher course as a way of updating their skills and abilities.

Are We Meeting the Re-Entering Nursing Training Needs?

The answer to this question is “sometimes.” Many areas of the state currently have no direct access to such training, with the local community college finding it difficult to maintain their own courses due to the high cost of providing such training. For a college that does not currently have a basic nursing program and the infrastructure that goes with it, attempting a nursing refresher course can be a daunting task. Several community colleges around the state of Texas currently offer classroom-based nursing refresher courses, and a few are currently developing new courses. At times, some of the existing courses (including the one at ACC) have more students seeking the training, than classroom seats available.

An effort has begun to help bring the nursing refresher course to previously underserved areas of the state, as well as provide alternative access to this training for colleges whose current courses have waiting lists. ACC's Health Professions Institute (HPI) is collaborating with Collin County Community College District, El Paso Community College, Midland Community College, North Harris College, the Texas Hospital Association, and STARLINK. This group has been awarded a one-year Perkins grant to develop a distance learning nursing refresher course. The funds from this grant will be used to creating a web-based (and CD-ROM based) version of the didactic portion of the nursing refresher course. This grant will also fund the development of technical manuals designed to guide colleges in the delivery of the skills-based clinical experience portion of the course in their local hospitals. Every effort will be made to tap the expertise of existing nursing refresher courses around the state, and utilize existing “best practices” in nursing refresher education. Nurses who have previously not had access to a refresher course, who cannot get into existing courses, or who need the flexibility of web-based course delivery, will all benefit from this new alternative. The web-based course will be delivered to any Texas community college that chooses to host it, through the Virtual College of Texas (VCT).

The nursing shortage will be with us for the foreseeable future. Increasing the number of qualified employable nurses is a primary goal for both nursing education and the healthcare industry. The American Hospital Association (AHA) reported that there are some 126,000 vacancies for RNs in U.S. hospitals alone (AHA 2001). This works out to be approximately one hospital-based RN vacancy for every 2,230 persons in the U.S. (American Association of Community Colleges, 2002). 65% of all hospital employee vacancies are for nurses, and the American Hospital Association (AHA) calls the nursing shortage “the most critical manpower problem facing hospitals across America” (AHA, 2001). The Texas Workforce Commission’s TRACER web site projects that 167,580 nurses will be needed in 2010, to meet the nursing employment needs around the state. That is a 26.7% increase in a decade. It’s estimated that 70,210 licensed vocational nurses will be needed in Texas in 2010, an increase of 17.8% over what was needed in 2000. It is our hope that the Distance Learning Re-Entry Nursing Update project will provide yet another pathway for valuable nurses to re-enter the clinical setting and get back to their role as a nurse in the delivery of patient care.

For additional information regarding the Distance Learning Re-Entry Nursing Update project, please contact (512) 223-7535, or e-mail to kwhite@austincc.edu.