The Montana Initiative
Margaret Wafstet - Project Director

In January 1998, the Montana Commissioner of Higher Education established a task force charged with the development of a plan for achieving a coordinated approach to nursing education within the Montana University System (MUS) and beyond the MUS. "The ultimate goal of the program will be to ensure that Montana has an educated nursing work force whose quality and quantity are geared to the health care needs of Montanans" wrote Commissioner, Crofts.

This task force brought together an unusually diverse group, representing not only nursing education programs, but health care providers, nursing regulation, and professional associations as well. In a state whose total population is 880,000, this group of approximately 26 stockholders were still able to fit around one large table. Accepting the Commissioner's charge, the task force reviewed Montana's five certificate programs in practical nursing, three associate degree programs leading to licensure as an RN, and three baccalaureate degree programs leading also to licensed practice as an RN. Following this review of the current status of nursing education and a wide range of options for nursing education, the task force developed full consensus on a plan of action, the Montana Model, that calls for:

* clarity of focus on the needs of consumers: students, employers, and patients,

* articulation: lateral and vertical movement within the educational system with minimal duplication,

* differentiation of the work of nurses at each level, based on respect for all levels of nursing and on demonstrated competencies, and

* partnerships between educational programs and between education, service and regulation to promote access, articulation, and diversity.

Specific recommendations to the Montana Board of Regents included:

1. simplifying and standardizing the degree taxonomy in use for Montana nursing programs: AAS for practical nurse, AS for associate degree, and BA/BS for baccalaureate;
2. adopting a common core of nursing course content and a common sequence of nursing courses at each level of education, in order to facilitate student mobility and credit transfer both laterally and vertically within the system;
3. making baccalaureate education more accessible through partnerships between baccalaureate programs at each associate degree site;
4. modeling differentiation in a variety of settings; and
5. investigating the possibility of establishing an RN to Master's program in the state.

The initial report of the task force was presented to the commissioner who praised the group's work and in July, 1998, the Board of Regents endorsed the plan. To date, three of the five LPN programs have submitted requests to grant the AAS within this year.

During the summer and fall of 1998, Task Force members presented the Montana Model to the State Board of Nursing, the Montana Organization of Nurse Leaders, the Montana Hospital Association, and the Montana Nurses Association. The plan was warmly received.

Through out its review and work, the task force members focused frequently on the needs of consumers and make a conscious decision to value all levels of nursing practice. In view of the fact that several previous attempts to standardize nursing education in the state had not been fully successful, the task force concluded that, in order to produce results that would benefit consumers in Montana, members would need to look beyond nursing education to nursing practice and regulation. The following vision statement was adopted.

Nursing education in Montana will work collaboratively to meet the needs of students, employers and patients by ensuring that Montana has an educated nursing work force whose quality and quantity are geared to the health care needs of Montanans. For nurses at any given level who may wish to further their education, programs will be articulated to provide maximum access with minimal duplication. Education, service and regulation will work in partnership to promote differentiated practice, based on respect for the competencies of nurses at all levels of education.

The task force reviewed available data on nursing work force projections, both at the national and state levels, and conducted its own survey of health care providers in the state in April, 1998. Findings revealed (1) both urban and rural health care providers in Montana are currently experiencing shortages of nursing personnel, (2) nurses are least well distributed in rural areas of the state, (3) shortages of nurses can reasonably be expected to escalate, and (4) anticipated demands for nurses vary by level of nurse and by type of health care setting. Thus the trend toward differentiation of practice was supported.

In January 1999, the Task Force invited nursing faculty, staff nurses, students and nursing leaders from around the state to participate in a conference with two nationally recognized consultants to introduce concepts of differentiated practice to a broader audience within the state.

The Montana Initiative joined the Colleagues in Caring Phase II of the Robert Wood Johnson Foundation Regional Collaborative for Nursing Work Force Development July, 1999. The task force has identified three working subgroups. These include an educational program articulation work group, a differentiated practice work group, and a work force projection work group. An October 1999, workshop with national consultants is planned to further develop nursing education articulation of nursing curricula and nursing practice differentiation with specific roles, competencies of nurses to be defined. Several inpatient settings have already expressed interest in participating as demonstration sites for differentiated practice. More dependable data on the state of nursing in Montana will be collected and analyzed this year.

At its inception, the work of the task force seemed impossible. Other groups had tried -and failed- to make sense of Montana's varied nursing education programs. What has emerged, however, is a shared vision and strong commitment to realizing a preferred future for nursing in this rural state. One of our members asked:

Will there be those of us who are so committed to the potential outcomes of the recommendations that we will step up and volunteer to be part of that leadership group that offers to continue on in the pursuit of what the Montana Nurses Association calls nursing's "preferred future"? We don't need anyone's permission or charge to continue the work begun here. We can individually and collectively be part of the leadership that energizes the actual and potential nursing practice toward the future.