practice between the RN and the LPN or unlicensed aide; the American Association of Critical Care Nurses (1990) has recommended five criteria to facilitate these distinctions.

Levels of nursing must be particularly differentiated with regard to the needs of an aging society because society still has the mistaken notion that the least well prepared are best suited to provide gerontological care when the converse is true (Aiken, 1990; McBride and Burgener, 1994). State strategies for health care work force reform must be encouraged (Pew Health Professions Commission, 1994c), particularly the establishment of a methodology for modeling work force needs by competency sets across the educational continuum.

Creating a More Educated RN Work Force

The aggregate supply of nurses is impressive, but there are too many ADN graduates and too few baccalaureate and higher degree nurses (Moccia, 1990; Aiken and Salmon, 1994). The Pew Health Professions Commission (1994a) has estimated, for example, that the number of graduates from nurse practitioner programs needs to double by the year 2000. Something must be done to provide incentives to community colleges to limit their number of graduates. Depictions of nursing must portray the career opportunities that are only available to baccalaureate and higher degree nurses, so the public is less likely to think that ''a nurse is a nurse is a nurse." Recruitment efforts must communicate in a visionary way the extent to which the professional nurse of the future is not like the traditional nurse of the past, so applicants can make informed career choices.

New kinds of articulation agreements (e.g., RN-BSN, RN-MSN) between community colleges and universities must be forged to facilitate mobility across programs and educational systems. This is of pressing concern because articulation strategies exist (Mathews and Travis, 1994), but the percentage of RN-BSN graduates has remained flat over the last decade (about 10 percent) despite the large number of ADN graduates and the many mobility programs (Salmon, 1995). Federal policies that deliberately encourage diploma nursing and ADN education are outmoded and must be reformulated to encourage baccalaureate and higher degree nurses who are in limited supply. For example, Medicare currently supports diploma nursing education, which is hospital owned; the Department of Education supports only ADN programs through the Perkins Act; and graduate education in nursing has none of the supports that are available to medicine through graduate medical education (GME) funds.

Reconfiguring RN Work Force Demographics

The nursing work force is aging more rapidly than the overall population. More traditional college-aged students must be recruited to the field since the proportion of RNs under age 30 declined from 25 to 11 percent between 1980 and



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