About Nurse Support Program II (NSP II)

Background

The Nurse Support Program II (NSP II) is funded by the Health Services Cost Review Commission (HSCRC) and administered by Maryland Higher Education Commission (MHEC). The goal of the Nurse Support Program is to increase the number of nurses in Maryland. NSP I supports hospital centered initiatives while NSP II focuses on expanding the capacity to educate nurses through increasing faculty and strengthening nursing education programs at Maryland institutions.

The Health Services Cost Review Commission (HSCRC) initiated nurse education support funding (formerly titled the Nurse Education Support Program or NESP) in 1986 through the collaborative efforts of hospitals, payers, and nursing representatives. In 2000, the Health Services Cost Review Commission (HSCRC) implemented the Nurse Support Program (NSP I) to address the issues of recruiting and retaining nurses in Maryland hospitals. In 2005, seventy-nine percent (79%) of the RN programs reported that they had met or exceeded their enrollment capacity. The shortage of qualified nursing faculty was identified as the fundamental obstacle to expanding the enrollments in nursing programs, thereby exacerbating the nursing shortage. The Health Services Cost Review Commission proactively created the NSP II to address the barriers to nursing education through statute with the Annotated Code of Maryland, Education Article § 11-405. Nurse Support Program Assistance Fund. At its May 4, 2005, public meeting, the HSCRC unanimously approved an increase of 0.1% of pooled regulated gross patient revenue for use in expanding the nursing workforce through increased nursing faculty and nursing program capacity in Maryland. On March 7, 2012, HSCRC approved modifications to NSP II to include increased doctoral education support for greater development of new and existing nursing faculty.

At the conclusion of the original ten years of funding, the HSCRC and MHEC staff completed a comprehensive program evaluation with the assistance of an NSP II Advisory Board. This Health Services Cost Review Commission’s report is public and available at http://www.hscrc.state.md.us/documents/commission-meeting/2015/01-14/HSCRC-Public-PreCommission-Meeting-2015-01-12.pdf. Many stakeholders provided letters of support. The data provided by NSP II competitive institutional grant project directors suggest that over 5,800 or 27% of all undergraduate nursing degrees produced between 2006-2013 are directly attributable to the NSP II competitive institutional grant program focused on increased graduations of pre-licensure RNs through redesigned curriculum options and new programs.

The HSCRC approved an additional 5 years of funding with recommendations to update the statute to better reflect nurses with the skills necessary to keep pace with the rapidly changing health care delivery system. Senate Bill (SB) 1081 was passed by both the Maryland Senate and House to delete the term “bedside” from the descriptor of nurses in the statutory provision establishing the NSP II and signed by Governor Hogan on April 26, 2016

Annotated Code of Maryland, Education Article
§ 11-405. Nurse Support Program Assistance Fund (a) "Fund" defined.- In this section, "Fund" means the Nurse Support Program Assistance Fund. (b) Established; status; administration; investments.- 1. There is a Nurse Support Program Fund in the Commission. 2. The fund is a continuing, nonlapsing fund that is not subject to §7-302 of the State Finance and Procurement Article 3. The Treasurer shall separately hold and the Comptroller shall account for the fund 4.The fund shall be invested and reinvested in the same manner as other State funds 5. Any investment earnings of the fund shall be paid into the fund (c) Composition.- The Fund consists of revenue generated through an increase, as approved by the Health Services Cost Review Commission, to the rate structure of all hospitals in accordance with § 19-211 of the Health - General Article. (d) Expenditures.- Expenditures from the Fund shall be made by an appropriation in the annual State budget or by approved budget amendment as provided under § 7-209 of the State Finance and Procurement Article (e) Use of money; guidelines.- The money in the Fund shall be used for competitive grants and statewide grants to increase the number of qualified nurses in Maryland hospitals in accordance with guidelines established by the Commission and the Health Services Cost Review Commission. (f) Guideline provision for minority recruitment. - The guidelines established under subsection (e) of this section shall provide that a portion of the competitive grants and statewide grants be used to attract and retain minorities to nursing and nurse faculty careers in Maryland. [2006, chs. 221, 222.][2016]

Goals of the NSP II

In 2010, The Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health. Nursing leaders organized in response to the clear action-oriented blueprint outlined in the 4 key messages and 8 recommendations identified by the IOM Committee. Nurses make up the single largest segment of the health care work force, estimated at 3 million nationally. They spend the most time delivering patient care. Therefore, they have invaluable insights and unique abilities as contributing partners with other health professionals in leading improvements in the quality and safety of care. While the nursing profession widely acknowledges the value of the IOM report, The American Journal of Nursing recognized the publication with the 2011 Book of the Year Award. It explores how nurses’ roles, education, responsibilities and competencies should change significantly to meet the increased demand for care that will be created by health care reform and advance the improvements in an increasingly complex health care system. These competencies include leadership, rapidly advancing technology, information management, system improvements, health policy, evidence-based practice, research, increased case management and community based health delivery. All of these are needed for increasingly complex care decisions to be coordinated within a collaborative interdisciplinary team. Since then, the recommendations have evolved and Assessing Progress on the IOM report, The Future of Nursing (2015) was released with additional guidance.

NSP II programs support the goals within the key messages of an improved educational system that promotes seamless academic progression, with higher levels of education and better information infrastructure for workforce planning and policy making.

The Need for Highly-Educated Nurses and an Improved Education System

Improving the education system and achieving a more educated workforce—specifically increasing the number of nurses with baccalaureate degrees—can be accomplished through a number of different programs and educational models, including: traditional RN-to-BSN programs; traditional 4-year BSN programs; collaborative educational partnerships to allow for automatic and seamless transitions from an ADN to a BSN; new providers of nursing education; simulation and distance learning through online courses; and academic-service partnerships. New approaches and educational models are needed to ensure curricula are readily adaptive to increasing technological and evidence-based changes in patient care.

In addition to increased numbers of BSN-educated nurses, schools of nursing must build their capacities to prepare more students at the graduate level who can assume roles in advanced practice, leadership, teaching, and research. While 13 percent of nurses hold a graduate degree, fewer than one percent have a doctoral degree. Nurses with doctorates are needed to teach future generations of nurses and to conduct research that becomes the basis for improvements in nursing science and practice. Recently, the Maryland Board of Nursing collaborated on an IOM committee survey to determine that approximately 600 nurses with doctorates practice in Maryland. Multiple partnerships and programs have joined in the effort to increase educational preparation for nurses to fill faculty roles, serve in joint clinical and faculty appointments and meet the needs of future students who will be entering the profession as Registered Nurses.

Four of the Future of Nursing 2010 Recommendations are deeply embedded in the programs of NSP II:

  • Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
  • Double the number of nurses with a Doctorate by 2020
  • Ensure that nurses engage in lifelong learning.
  • Build an infrastructure for the collection and analysis of inter-professional health care workforce data.

Administration, Application Process, Implementation and Evaluation

Nursing programs submit proposals for grant projects that address their specific educational needs. A multi-stakeholder evaluation committee reviews the proposals and works with designated institutional project directors to ensure compliance with the original approved project with any changes supporting the overall goals of the NSP II. Nursing programs submit annual reports that describe measurable outcomes of their program along with annual budget reports. MHEC provides ongoing oversight through site visits, as well as coordination and approval of all program or budget revisions. Statewide initiatives require individual nominations and application submissions for graduate nurse faculty scholarships, faculty fellowships and nursing educator doctoral grants. These initiatives include concurrent or future expectations of a service commitment to a Maryland nursing program in a faculty role. Funding is provided by the Health Services Cost Review Commission through 0.1% of the hospital’s gross regulated patient revenue for the previous year. Program evaluations are summative, based on outcomes reported through each awarded institution and grantee. Annual reports and recommendations are submitted by NSP II program staff to the Health Services Cost Review Commission.