PROVIDENCE – If women hold up more than half the sky, then nurses hold up more than half of the health care delivery system.

But, like the character portrayed by Rodney Dangerfield, nurses often don’t get any respect.

Witness the recent legislation, RI H-5481, proposed by Reps. Art Handy, David Bennett, Raymond Hull, Scott Slater and Christopher Blazejewski, which seeks to repeal the Nurse Licensure Compact, governing state licensing requirements.

The underlying reason to repeal the existing law, it appears, is to make it more difficult for hospitals in the midst of labor disputes to hire out-of-state nurses if those disputes turn into strikes. The proposed legislation is now before the R.I. House Corporations Committee.

Then there is the new 28-member working group created by Gov. Gina Raimondo to redefine Medicaid in Rhode Island, which includes only one nurse and one Medicaid recipient. It would seem that if you wanted to understand how to reinvent Medicaid, you’d want to talk with the folks who are actually delivering the care, and who are receiving the care, and not just their bosses.

Construction is now underway on the project that will convert the former South Street Power Station into the Rhode Island Nursing Education Center, a shared space for the University of Rhode Island and Rhode Island College Nursing programs. The real economic driver is not the nursing center but the new educational offices being created for Brown University, which has a lease agreement to occupy half the building, some 136,000 square feet.

The project to refurbish the power plant will include construction of graduate student housing, a new parking garage, 500 construction jobs and 375 indirect jobs, generating $5 million in income and sales tax during construction, according to the developer Richard Galvin of Commonwealth Ventures.

“Reaching this important milestone in this highly complex project has required the commitment and tenacity of our private and public sector partners,” said Brown President Christina Paxson, at the groundbreaking on Dec. 15, 2014. “Today, we set the stage to transform a staggering liability into a gleaming asset, providing opportunities for meaningful academic connections that will have lasting benefits for our institutions, our city, and our state.”

Yes, women hold up more than half the sky, as nurses hold up more than half the health care delivery system, and nursing education programs will support more than half of the new South Street Landing Project.

But, more than building a building and calling it a joint education center, the infrastructure that supports nursing education in the state needs some immediate attention, investment and repair.

Collaboration in name only
The two nursing programs from Rhode Island College and the University of Rhode Island may be sharing space at the new nursing center, but the programs will be located on separate floors, with separate curricula. It is very much a forced marriage brokered by powerful state politicians; the two programs will be residing in separate bedrooms.

And, at this point, despite the fact that Brown University Medical School will be a block away, there is little if any planned or ongoing collaboration between the nursing schools, their facilities and courses, and Brown.

Similarly, collaborations between the nursing programs with the new Johnson & Wales University Center for Physician Assistants program, locate two blocks away, have not, as yet, been developed.

Nor has there been any formal collaborations developed with the Rhode Island Nurses Institute Middle College.

Not passing the grade
Three of the six Rhode Island nursing education programs did not meet the 80 percent standard for students passing the National Council Licensure exams last year, known as NCLEX, according to reports from the R.I. Board of Nurse Registration and Nursing Education.

New England Institute of Technology has a pass rate of about 64 percent; the University of Rhode Island had a pass rate of about 75 percent, and Salve Regina had a pass rate of about 78 percent.

Rhode Island College, in turn, had a pass rate of about 93 percent.

Letters have been sent to the three schools of nursing – NEIT, URI and Salve Regina – with less than an 80 percent pass rate, asking them to submit an analysis of the problem, according to the board of nursing minutes. In addition, the three schools must submit a plan of correction by July 1, 2015, for review by the board of nursing.

Neither the University of Rhode Island nor Salve Regina responded to inquiries by ConvergenceRI regarding the low rate of passing the nursing licensing exam by students. The New England Institute of Technology said that they would be able to respond early this week.

[Update: Steve Kitchin, spokesman for New England Institute of Technology, told ConvergenceRI on March 4 that the school had submitted its action plan in to address and to correct any problems in December. "We have raised the admissions standards and the standards for the nursing program," he said.

The school has also began using a series of prep tests for students to help students better prepare for the licensing exams. In addition, policies and procedures have been tightened and curriculum changes have been made.

"Everything we do is focused on labor market demands," Kitchin said, explaining the quick response to correct any deficiencies.

In addition, Dayle Joseph, the retired fomer dean of Nursing at the University of Rhode Island, was hired as the new director of the NEIT program.]

The low pass rate may also have consequences for many of the students and their student loans.

How important is nursing education to Rhode Island’s job growth? The numbers tell the story. The R.I. Department of Labor and Training has forecast that by 2018, more than 4,500 nurses will be needed to fill the growing needs for nurses in the state’s health care delivery system.

Competition vs. collaboration
The apparent lack of collaboration between the state’s nursing education programs is colored by an increasingly competitive environment for nursing students. It also mirrors the competition being played out between large hospital systems in Rhode Island for patients.

Some 41 employees were laid off at Care New England's Women and Infants Hospital, it was announced on Feb. 23. There were no nurses or physicians affected, according to spokeswoman Amy Blustein. No breakdown of the positions was given, other than to say that they were from across the organization.

Blustein said that the hospital’s market share had not declined, but the actual number of deliveries, surgeries and outpatient volume throughout Rhode Island had declined.

“Simply put, there are fewer patients seeking care in an increasingly competitive market,” she said.

[The head-to-head competition between Women and Infants Hospital and Lifespan for the women’s health market has had an impact, according to a staff member at Women and Infants.]

Blustein said the hospital system has sought to improve efficiency with fewer patients. “We have worked with our bargaining units to institute schedule redesign in several departments that has enabled us to adjust our staffing in keeping with actual patient volumes,” she said.