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Nursing Tug of War

January 7, 2010

A new study by the Carnegie Foundation for the Advancement of Teaching recommends that the bachelor of science in nursing be required of all those seeking to work in the field.

Currently, many enter the profession with an associate degree in nursing. Instead of considering these community college graduates a part of the solution to the nursing shortage, the Carnegie study states they should not practice without first moving on to further study. Given its call to boost the minimum educational level for entry into the field, the study calls for those in the nursing profession “to agree on how to transform the current diverse pathways into a unified whole.”

Patricia Benner, director of the Carnegie study and professor emerita at the University of California at San Francisco School of Nursing, said such a change would hold community college nursing programs more accountable.

“The fact is that that the minimum amount of time a student has to spend in these ‘two-year programs’ is actually three years,” Benner said of community college nursing programs. “And, most often, it takes students four to five years to complete them because of over-subscribed courses, underfunding and a year of prerequisites before entering the actual nursing coursework. Also, many of these programs have long waiting lists to get in. … If the baccalaureate were made the minimum requirement for entrance into the field, I think the community college programs would at least have to be more honest about how much time it takes students to get through their programs and how much opportunity cost is there for them.”

Only 16 percent of community college nursing graduates go on to earn a baccalaureate degree, Benner noted. Since associate-degree nurses make up 60 percent of all nursing graduates, she argued that this makes for a severe shortage of nurses who are educationally qualified to seek advanced education and possibly become nursing faculty, of which there is currently a considerable deficiency.

“I’m not against community college nursing programs, and this is not a diatribe against community colleges,” explained Benner, herself a product of an associate degree program at Pasadena City College early in her career. “But something is out of whack when they get a degree that doesn’t allow them to go on to advanced practice. It’s just not adequate to meet current demands.”

The Carnegie study calls for community college nursing programs to seamlessly articulate their programs at the two-year mark with an affiliated baccalaureate nursing program. Benner noted that these transfer initiatives should enable nurses to complete baccalaureate degrees in about four and a half years.

“It would be difficult to lose the education capacity of the community college for nurses, but the current system is in need of radical reform and redesign so that nurses are better prepared for the current demands of their practice,” wrote Benner in an e-mail, adding that the Carnegie study also suggests that students be provided with more articulated pathways to earn the master of science in nursing within 10 years of earning basic nursing training.

Advocates for community college nursing programs, however, take issue with some of Carnegie’s policy recommendations.

“I teach in a rural setting and a main advantage of offering a two-year RN degree is that it puts the nurse graduate to work in a shorter amount of time so they can support their family,” wrote Kim Tinsley, a member of the National Organization for Associate Degree Nursing’s Board of Directors and a nursing professor at North Arkansas College, in an e-mail. “They cannot afford to attend four years of B.S.N. classes and not work. The A.D.N. student does sometimes take up to four years to complete their degree, but it is due to the fact that they are working (sometimes full time) and have a family to support. The average age of our student is 27. The majority of our students are either married with a family or are a single parent. They cannot afford the time nor resources to attend a four-year program.”

It is the official position of the N-OADN that a baccalaureate degree in nursing should not be required for “continued practice beyond initial licensure as a registered nurse.” Tinsley explained that any change to the status quo would violate the choice community college nurses have in whether they want to pursue further education.

“Access is a huge barrier,” Tinsley wrote. “We believe in continuing education but it should not be a mandatory requirement. The B.S.N. and the A.D.N. graduate take the same [National Council Licensure Examination] upon graduation. There is no valid research that shows a safety discrepancy between levels of education. Many A.D.N. graduates assume bed side nursing positions and provide direct patient care in a variety of settings, not just the hospital setting. They also fill management positions. There is no evidence that they are not prepared for current practice.”

Patricia Smart, secretary for the N-OADN board and nursing professor at Delgado Community College, echoed a similar sentiment. She expressed her displeasure with the Carnegie recommendations, arguing that requiring all nurses to have baccalaureate degrees “would cripple the nation’s supply of nurses at the bedside.”

Though acknowledging it is likely the most controversial recommendation in the Carnegie study, Benner said the Carnegie study does not dwell on the associate-versus-baccalaureate degree issue. Among other recommendations, it also encourages programs across the board to “broaden the clinical experience,” “vary the means of assessing student performance” and “redesign the ethics curricula.”

“We want to upgrade and improve the education of nurses whether they’re in associate or baccalaureate programs,” Benner said of the goals of the study’s authors.

 

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