Detente on Nursing Education

October 9, 2008

For better or for worse, there is more than one way to become a nurse. And while this ought to be cause for celebration -- especially when there is such a shortage of nurses -- it is more often the cause of conflict. Community colleges and universities frequently clash over state funds, the value of their graduates, and who better serves the market. Now, in a growing trend, some states are realigning their two- and four-year nursing programs to encourage more collaboration and fewer obstacles toward earning an advanced degree.

Last week, the Foundation for California Community Colleges announced the recipients of a grant that, through collaboration between two- and four-year programs, will help develop a new model for nursing education in the state. Though community colleges provide the lion’s share of new registered nurses in California -- about 70 percent -- there is a growing need for highly trained and specialized nurses who hold at least a bachelor’s degree. This new collaborative program is being developed among 50 of the state’s 130 nursing schools: at a number of community colleges, select California State University campuses and a few private colleges.

Currently, only 26 percent of nurses holding associate degrees in California continue their education to earn a bachelor’s degree. Kristine Yahn, director of health care programs at the Foundation for California Community Colleges, said she believes that this new collaborative program between the state’s two- and four-year nursing programs could bolster that percentage on the way to helping meet the forecasted state-wide shortage of 116,000 nurses by 2020.

“There is a potential crisis with the basic nursing shortage and the pending resignation of large numbers of faculty, deans and directors of [nursing programs at] colleges and universities,” Yahn said. “Literature has shown clearly that advantages in outcomes can be and are attained in patients with baccalaureate-trained nurses at the bedside. A better educated nursing workforce is something we should all be striving for.”

While, as in most states, a bachelor’s degree is not required to become a staff nurse in California, it is essential for those who want to achieve a leadership role or work in a specialized medical field. Deloras Jones, executive director of the California Institute for Nursing & Health Care, said this professional ambition is, for some, incentive enough to pursue further education, but this isn't the case for everyone. She added that, at the staff nursing level, there is little pay differential between those with an associate degree and those with a bachelor’s degree.

“Nurses are quick to say, ‘Why should I go on to get my bachelor’s degree if I don’t need it to be at the bedside?’” Jones said, noting that California’s highly unionized system narrows the pay differential between more and less qualified nurses. “That may be true, but the door to the development of a professional nursing career is opened through higher education. A staff nurse with an associate degree will find it more and more difficult to move along the continuum of a professional career.”

The collaborative program being developed in California is different than a standard articulation agreement or 2 + 2 program between a community college and a four-year institution. Jones said nurses in the program will be offered dual admission to both a two- and four-year institution to ensure their continuation and so they would avoid the common pitfalls of having to transfer. Additionally, she said, participating programs will have a shared curriculum, so that nursing students will not take redundant courses at the associate and baccalaureate level. In theory, Jones explained, a nursing student will take a year of prerequisites at a community college, spend two years earning an associate degree at a community college and complete their bachelor’s degree in an additional year at a four-year institution. Proponents argue this will streamline the process, quickly training more highly educated nurses than could be done previously.

The proposed California system was modeled after a collaborative nursing education program in Oregon, whose first class of nurses will earn bachelor’s degrees in the spring. The Oregon Consortium for Nursing Education, formed in 2001, is a program between 8 of the state’s 14 community colleges and Oregon Health & Science University. As in the California program, students are whisked through their nursing programs in a less obstructive fashion on their way to earning a bachelor’s degree. Louise Shores, the consortium's director, said the program has generated significant interest from 25 other states that are seeking to emulate it in some fashion. In the past, she said only about 18 percent of nurses earning an associate degree pursued a bachelor’s degree. Since the introduction of the program, however, she said participating institutions have seen that figure rise to around 50 percent.

Though the Oregon program has interested many other states and is already generating noticeable results, Shores said it was initially difficult to convince both the two- and four-year institutions that it was an idea even worthy of consideration. Recently, the Oregon Nurses Association lobbied that a bachelor’s degree be required to become an entry level nurse in the state. This failed movement, she said, was the basis for some of the conflict between the community colleges and four-year institutions that made the program difficult to sell.

“There were a lot of stereotypes and tensions brewing and breeding,” Shores said. “The baccalaureate programs tended to be snobbish about their higher level of education and tended to think of themselves as better. On the other hand, some of our biggest detractors were community college presidents who viewed this program as a backdoor toward mandating a baccalaureate education for nurses. There was a lot of animosity early on that we needed to turn around.”

The development of collaborative nursing programs is not an isolated phenomenon, said Mary Jean Schumann, chief programs officer at the American Nurses Association. She noted that almost every state is taking some approach to remodeling its system to meet the great demand for nurses.

For example, the Community College of Baltimore County and Towson University are starting a similarly collaborative program in which students will earn associate, bachelor’s and master’s degrees in nursing. New programs are also in place to educate nurses beyond the baccalaureate level. Mount St. Mary’s College, in California, is starting a program that will train nurses with associate degrees to earn a master’s degree in nursing in three years. Additionally, the Texas Tech University Health Sciences Center is starting a doctor of nursing practice program, in response to the shortage of qualified nursing faculty members.

“We have a nursing shortage that isn’t going to right itself,” Schumann said. “We also know that we want nurses to have a bachelor’s degrees at the end but recognize that nurses will come through a program any way that they can. We’re all for reducing the barriers as long as the quality of education is the same at the end of the day.”

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