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Educating the Nurse of the Future

Keene State's new nursing major will help shift nursing education and practice to a 21st-century model, one that recognizes and meets the complex demands of the job today.

by Susan Peery

homas Connelly, Mary Ellen Fleeger and Carolynn Ernst photo by Mark Corliss

The nursing program's new team (from right): Director Thomas Connelly and professors Mary Ellen Fleeger and Carolynn Ernst. A third faculty member, Cindy Cahoon, and administrative assistant Shelley Green also began work this summer.

Keene State's newest academic program puts the College smack in the middle of a national conversation about health care, and in a position to make a difference in the outcome. Several years ago, Governor John Lynch and Steve Reno, then chancellor of the University System of New Hampshire, identified an imminent shortage of baccalaureate-educated nurses (expected to hit the state in 2015) and recommended expanding nursing education to Keene and Plymouth. At the same time, the nursing profession was taking a hard look at its own educational models and whether they fit the state of nursing practice.

The American health care system, as it was established about 100 years ago, was built around treating acute illnesses, communicable diseases, and injuries. But the health challenges facing us today are different. Most care relates to chronic conditions (diabetes, hypertension, arthritis, cardiovascular disease, and mental health conditions) experienced by an aging population and compounded by increasing levels of obesity. New technology demands high-level skills and the ability to access information and make fast decisions. Modern health care requires a team approach and the ability to navigate a complex world of regulations.

As the plan to develop a nursing program gathered steam, new USNH Chancellor Ed McKay, KSC President Helen Giles-Gee, Provost Mel Netzhammer, and Dean of Professional and Graduate Studies Melinda Treadwell threw their support into solving the questions of curriculum and licensing requirements, budget and space considerations, faculty development, and the community cooperation that would be needed for a successful program.

"And just as a nurse's first priority with a patient is to assess the situation, we will also assess who we are as a department, what we can bring to the campus and the community, and how we can truly go forth to serve."

In a fortunate coincidence, two of the people who have been key in developing KSC's new nursing major arrived here with the same vision for the program. Both are top-level higher-education administrators. Both began their careers as nurses. Both believe in the power of a liberal-arts education. And both know that the way we educate nurses has to change.

Mary Ellen Fleeger was USNH associate vice chancellor for academic and student affairs from 2003 until this summer. While working in that position, she also helped spearhead successful efforts over the last two years to start nursing programs in Keene and Plymouth. A registered nurse who holds bachelor's and master's degrees in nursing and public health, respectively, she is joining Keene State's new nursing faculty.

Thomas Connelly, the new director of Keene's nursing program, left his job as president of St. Elizabeth College of Nursing in Utica, New York, to come to Keene. He has a wide variety of nursing experiences, including practice, education, research, and administration. He served on the "Nurse of the Future" initiative in Massachusetts for several years, and was drawn to KSC because the new curriculum is based on the recommendations of his initiative and those outlined in The Future of Nursing, a landmark report by the Institute of Medicine (see

"I feel so privileged to help bring this to life," Connelly said. "We will be pioneers in implementing the new approach. We will explore the ways that nursing can partner with other disciplines in a liberal arts college. We will help nursing students discern that this is a commitment to lifelong learning. And just as a nurse's first priority with a patient is to assess the situation, we will also assess who we are as a department, what we can bring to the campus and the community, and how we can truly go forth to serve."

Registered nurses have historically come to their profession in one of two ways – by getting a bachelor of science degree in nursing (BSN) and passing the RN licensure exam, or by earning an associate's degree in nursing (ADN) from a two-year program and then passing the licensure exam. The goal of the new initiative is to increase the number of BSNs in the workforce, taking advantage of the diverse background provided by a liberal arts education combined with professional training. Improving the nursing care provided to patients will in turn improve health outcomes. The BSN initiative also positions nurses for better pay and better opportunities for advancement to leadership and teaching roles, all sorely needed.

"The most complicated curricular problem we had to solve was how to create seamless articulation from an associate's degree to BSN," explained Fleeger, "which requires cooperation with community colleges and nursing schools, and agreement on the content and portability of all coursework." Fleeger's outline of seamless progression from high school to two-year and four-year programs, based on models she helped develop in Oregon and on the work Connelly was involved with in the "Nurse of the Future" initiative, helped define the program Keene is offering.

Keene State's nursing program has two tracks. One, for students entering college, will admit 32 students for the spring 2012 semester. For the first two years, they will take required integrative studies courses and some nursing prerequisites before progressing to the nursing major in their junior year. Students in this program, called "pre-licensure," will take a minimum of 16 credits per semester.

The second track, called "RN completion," is for current registered nurses who hold an ADN. KSC will admit 16 RN completion students in the first cohort. They will earn 32 nursing credits as well as completing other requirements for a BSN. Because most students in the RN completion track are also working as nurses, it is expected that they will take eight credits per semester to complete their degree. (For specific requirements for both tracks, see

"The nursing major is good for Keene State in several ways," noted Dean Treadwell. "It meets the state's needs; it allows KSC to develop a program grounded in the liberal arts, which meets our mission; and it serves a national need for liberally educated nurses with critical skills. In order to do this, the campus had to come together to create a curriculum – biology, health science, chemistry, athletic training, psychology – that meets accreditation. Our program also requires a world language, as part of a true liberal arts education.

"Collaboration was not just among faculty but with other institutions in the area," Treadwell continued. "We met with a regional nursing consortium dedicated to bringing nursing education to our area. The Keene Chamber of Commerce did a needs assessment, which was very helpful. We worked with River Valley Community College to ensure good transfer of credits. They will begin requiring their nursing students who intend to get their BSN to take statistics. We will be able to use their simulation lab, and we'll be able to use the testing labs at Cheshire Medical Center/Dartmouth-Hitchcock Keene. Clinicals will be at Cheshire Medical Center, Monadnock Community Hospital, Brattleboro Memorial Hospital, and psychiatric facilities in the area."

This summer, as the State Board of Nursing accreditation visit neared, Fleeger, Connelly, new administrative assistant Shelley Green, and two new faculty members were busy moving into the second floor of Keddy House. The Admissions Office, swamped last spring with nursing applicants, was getting ready to receive applications for the second cohort of students. And somewhere, the spirit of Florence Nightingale, mother of all nurses, was smiling. "Nursing," she once said, "is an unending process of learning."

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