External Factors Influencing Nursing Programs

Instructor: Jennifer Reyes

Jennifer has taught Nursing in ADN, BSN, and MSN programs and has a Master's degree in Nursing Education.

This lesson takes a look at the external factors that can influence nursing programs such as funding, regulation, accreditation, availability of clinical sites, as well as demographics of students. In addition, this lesson will address methods used by Certified Nurse Educators to adapt and implement to these factors.

External Factors Influencing Nursing Programs

Nurses are in high demand these days. It's hard to not turn on the TV, radio, or search the internet without seeing an ad to become a nurse. And yet, upon researching available nursing programs there aren't as many available as you might have hoped. In addition, most of the time the list of requirements and wait to get in makes it seem unattainable.

There are many factors within the program, as well as outside the program, that can have an impact on the nursing program and its success. Sources of external influences include financial funding, rules and regulations, accreditation, availability of clinical sites, and institutional factors.

Financial Funding

Funding within healthcare is heavily influenced by patient care services and successful outcomes of those services. Thereby, nursing programs must be diligent to produce successful nursing students who can perform patient care services well. Financial funding of public nursing programs is often dependent on the NCLEX pass rate, which will reflect if patient care services and critical thinking skills are adequate enough to be successful as a nurse within a hospital system. Limited funding can greatly impact a nursing program. It can lead to limited class sizes and enrollment each semester, adding to the nursing shortage.

In addition, institutional budget cuts and limited funding can cause an increase in tuition for students. The increase cost of any nursing program can make it very hard for those who wish to become a nurse, pursue and succeed. Many students may be forced to work while in nursing school, leading to increased stress and poor overall health and well-being. Without sufficient financial funding, nursing programs may be forced to decrease the number of nursing faculty they are employing. This can also contribute to the limited number of students accepted and educated each semester, as well as lead to an increase workload for existing faculty. The increase workload can lead to feeling overwhelmed, stress, and burnout.

Availability of Clinical Sites:

Clinical education refers to the hands-on learning that takes place outside of the traditional or online classroom. In nursing, clinical experiences most often occur within the hospital setting and within the specialty areas, such as adult medical/surgical units, ICU, pediatrics, labor and delivery, and sometimes the operating room. The availability of clinical sites will strongly influence the success and influence of any nursing program.

How clinical sites become available to programs is two-fold. Many times, an agreement is made between hospital/agency and school. Both parties are apt to benefit from this arrangement, as the school will have an opportunity to provide quality educational experiences and meet the mandated clinical hours needed for students to complete the program, while institutions have an opportunity to house and recruit new nurses. If a school cannot produce students who are knowledgeable and competent of nursing material, while functioning independently, this may impact the agreement. An institutions reimbursement may rely heavily on federal funding.

Nurses play a key role in helping these institutions retain as much funding as possible. Positive, friendly, and intelligent nursing students are sought after to help with the success of the institution. Clinical experiences can influence this perception. In addition, over recent years, clinical sites have been bombarded with nursing programs and have created competition for these sites. External influences that have pushed for more BSN degrees within the nursing workforce and has led to many of the clinical spots to go to those programs. Other programs, such as ASN or diploma programs, are left with minimal options and are often forced to seek clinical experiences elsewhere, in non-traditional institutions, or supplement clinical time with simulation experiences.

Simulation, while it can be an excellent learning resource, is a large undertaking for any nursing program. The equipment itself is very expensive to purchase as well as maintain. In addition, time and training of faculty is needed in order to create successful and engaging simulations. This can create a large demand on educators to develop these scenarios and learn how to use the equipment.

Rules and Regulations

National, state, and local government rules and regulations can have a direct impact on nursing programs and the care nursing students can provide. These rules and regulations are often influenced by global health care issues such as access to care and safety. As access to health care changes, safety issues evolve, and the roles and scopes of regulatory agencies are better defined, the rules and regulations must correspond with the changes. As these rules and regulations change, the nursing program must also adapt. This can create an increase workload demand on educators who must adapt curriculum and learning activities to reflect the appropriate level of knowledge.


Accreditation refers to the act of recognizing a school or program as having achieved all the standards deemed necessary and are thereby qualified to provide a nursing education to students. Accreditation requirements heavily influence nursing programs, both public and private. There are a few different agencies that can monitor accreditation of a given program. Whether a program is accredited and by whom can impact who attends the program because accreditation status can impact students who wish to further their career and education. Accreditation standards are believed to focus on the quality of an educational nursing program, thus impacting the nursing pass rate on the NCLEX exam and success rate in the workforce. Program accreditation has been linked to improved patient outcomes.

The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are two gold standards of nursing program accreditation. In addition, the state board of nursing also has accrediting powers over a nursing program. These agencies oversee the curriculum of the nursing program to ensure that it meets the standards of today's patient care. The agencies mandate that the amount of classroom and clinical time must be achieved in order to deem a student as successful of passing the course and eligible to sit the NCLEX examination. Without an accreditation stamp of approval, funding and enrollment rates can be drastically changed. Also, any type of discipline or change action required by a program as deemed necessary by one of these accrediting agencies, can create a curriculum change leading to increased stress and workload of faculty and students, and may create more chaos within the program itself.

Institutional Factors

The Institute of Medicine published a report entitled ''The Future of Nursing: Leading Change in 2010''. In the report, it urged that a majority of the nursing workforce (80%) should be bachelorette prepared by 2020. This factor has led many nurses to go back to school in order to keep their jobs and sustain their families. This has thereby lead to the creation of or re-vamping of many existing nursing programs to BSN programs. The changing of times and demand for BSN prepared nurses has generated an increase in RN-to-BSN programs and BSN programs. Those nursing programs trying to keep up with the times are forced to redevelop their curriculums to reflect a bachelorette level of thinking. In addition, existing students and stakeholders must be kept abreast of changes.

These changes can influence the perception the nursing program and generate conflicts that affect the success of the program. Magnet Status refers to a specific award that is given to hospitals that achieve certain quality and safety standards. It is a testament to the quality and strength of their nursing. Hospitals that have achieved this status are found to have better patient outcomes, lower mortality rates, and better work environments. Two attributes of this award is that 100% of the nurse managers should have a BSN degree or higher and more than 50% of the nurses staffed on each unit should be certified in their field.

This may not seem like a concern of a nursing program, but as more and more hospitals strive to achieve this status, there has been a greater push for more BSN prepared nurses, as well as those who possess the quality of on-going learner so that they may become certified. This can definitely influence nursing programs, again to meet the demands of BSN curriculum, as well as strive to create a diversified student population with a wiliness to continue learning. Those not willing to become certified could potentially be deemed as a ''student from X school'' and tarnish the reputation of that program.

Examples of Methods Used by CNEs to Adapt to These Changes

Katie is a nurse educator within a nursing program at a local community college. She teaches nursing fundamentals to first semester students enrolled in an ADN program. Over the last few semesters, each incoming class has had fewer students in it. Due to the decrease in enrollment a fellow semester, one instructor has been let go. Katie was asked to pick-up the slack and teach the complimentary clinical for her course, as well as teach the therapeutic communication course. Katie found herself very overwhelmed the first few weeks of class.

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