As hospitals increasingly prefer nurses with bachelor’s degrees, community colleges are developing innovative ways to ensure nursing students have an opportunity to continue their education.
Some have agreements with universities for dual enrollment, for example, while others have formed partnerships allowing for a seamless transition to university-level programs with shared faculty and curriculums or plan to expand their programs to offer bachelor of science in nursing (BSN) degrees.
The drive toward encouraging more nurses to have BSNs comes from the 2011 Future of Nursing report by the Institute of Medicine, which set a goal of having 80 percent of nurses nationwide with BSNs by 2020.
Hospitals pursuing “magnet” status under the American Nurses Credentialing Center must have a plan to achieve that goal.
A 2016 survey by the American Association of Colleges of Nursing found that 54 percent of hospitals and other health settings require new hires to have a BSN, up 6.6 percentage points since 2015, while 98 percent of employers have a strong preference for BSN holders.
As a result, community college nursing program advocates have shifted their focus from maintaining the associate degree in nursing (ADN) as the only required credential for registered nurses to helping students pursue more advanced degrees.
Currently, just over half of U.S. nurses have a BSN and 57 percent of nurses began their nursing education at a community college.
“We want to be sure students, regardless of where they obtain an ADN, have an opportunity for academic progression,” says Christy Dryer, president of the Organization for Associate Degree Nursing (OADN), an affiliate of the American Association of Community Colleges.
“That doesn’t stop with the BSN. We want them to have opportunities for a master’s and doctorate degree, too,” says Dryer, who also serves as dean of nursing and health professions at Cecil College in Maryland.
In selecting a program, the most important factors for students tend to be cost and the length of time to a degree, says Cynthia Maskey, dean of health professions at Lincoln Land Community College in Illinois, and a member of the OADN board.
“That’s why it’s important that community colleges have good agreements, including discounts, with university partners,” Maskey says.
While it has generally been believed that ADN-prepared nurses do as well or better than BSN-prepared nurses on the National Council of State Boards of Nursing’s NCLEX licensing exam, the last time that happened was in 2005, notes Donna Meyer, chief executive officer of OADN.
The passing rates in 2016, through September, were 88 percent for nursing graduates with BSNs and 82 percent for those with ADNs.
Because ADN programs are shorter, it’s difficult to fit everything into the curriculum, Meyer says. Newer versions of the exam cover more material on research, management, leadership skills and the economics of healthcare, and those topics are not covered as extensively in two-year programs.
In OADN’s view, “the ADN is not the end all by any means,” Meyer says. “Our whole mission is about academic progression. The ADN is still a great entry point, but nurses need to have a chance to continue their education.”
The employment issue varies regionally, she says. In urban areas, it’s difficult to get a job without a BSN, while it’s not so much of a problem in other areas.
“In many communities, if it wasn’t for the community college, they wouldn’t have nurses in their community,” she notes.
Cecil College, which has 10 articulation agreements with universities to help nursing students pursue a BSN, enrolled its first cohort of dual-enrollment nursing students this fall.
Students working on an ADN at Cecil can concurrently work on a BSN online from the University of Maryland or through a mix of online and in-person courses at Towson University, says Dryer.
Nursing students take their foundational courses and do their clinicals at Cecil. The BSN courses cover topics like research, nursing leadership and nursing theory – courses RNs need if they want to progress in their careers.
There are plenty of applicants for nursing jobs in the community, but Dryer expects to start seeing a nursing shortage in 2018. “Already, Cecil graduates are reporting that it’s easier to get a job than it was a few years ago, and hospitals are getting a little more aggressive in recruiting.”
Northwestern Michigan College (NMC) is also ensuring its ADN graduates have an opportunity to continue their education through a dual-enrollment agreement.
While completing an associate degree at NMC, students can take classes from Davenport University leading to a BSN – without having to leave their campus. The university hired some of NMC’s adjuncts to teach bachelor-level courses at NMC. The first cohort of seven students just graduated.
Cost and convenience
The partnership between NMC and the university is a financial-aid agreement, which covers the higher tuition at the university, says Director of Nursing Laura Schmidt. It enables students to save money and stay in town, as there aren’t any university-level nursing programs nearby, she says. While students can take online courses from Davenport or other universities, that isn’t an option for NMC students who live in rural areas and don’t have good internet connections.
Some of the nursing students at NMC are recent high school graduates, and some are already working as nursing assistants or paramedics, Schmidt says. Others already have bachelor’s or master’s degrees in unrelated fields, such as business or engineering, and were either laid off during the recession or decided they would rather work in healthcare.
Nursing students at NMC are motivated to continue their education by the nationwide push for RNs to attain BSNs, she says.
Munson Medical Center, a “magnet” hospital and the only hospital near NMC, still hires RNs with ADNs but requires them to earn a BSN within five years, Schmidt says. The hospital helps students pay for their continuing education – providing about $5,000 a year to help them earn bachelor’s degrees.
That’s a positive step for the nursing profession, says Schmidt. “Students should continue with their education. With an associate degree, they are prepared to do the work. But having more education and more knowledge helps them be better nurses and better able to work with patients.”
One barrier to expanding nursing programs in higher education is a growing shortage of faculty. Among NMC’s eight nursing professors, two retired and two returned to the practice of nursing last year, and another three are expected to retire this year.
It will be hard to replace them, Schmidt acknowledges. Colleges require nursing professors to have master’s degrees and can’t match the salaries paid by hospitals.
Several clinical instructors at NMC also have full-time jobs at Munson. The medical center allows qualified employees to reduce their hours so they can teach a course or two at the college as adjuncts – while retaining their full-time employment status at the hospital.
The nationwide shortage of nursing professors will only get worse, due to the aging population and pay disparity.
“It’s a huge problem in some places, especially rural colleges, and it’s going to become a bigger problem everywhere,” Maskey says. “Hospitals can give bonuses to new hires; community colleges can’t do that.”
Lincoln Land Community College, however, doesn’t have a shortage of nursing teachers at the moment, she says. “We do a lot of ‘grow your own.’ We encourage students to get advanced degrees and come back and teach,” she says, noting that the college prefers nursing professors who have experience in the workforce.
BSNs at community colleges
To meet employers’ demand, Lewis and Clark Community College (LCCC) in Illinois is urging the state legislature to allow community colleges to offer BSNs.
“The hospitals we collaborate with told us they want to hire BSNs,” says LCCC President Dale Chapman. They still hire nurses with ADNs but require them to earn a BSN within a specified time.
Rather than a start-to-finish BSN degree for new nursing students, LCCC proposes an RN-to-BSN model targeting working nurses with ADNs who want to come back to LCCC for a semester or two to complete a bachelor’s degree.
The cost would be just $3,800 a year, a much more affordable option than where many local RNS go for a BSN, Chamberlain College of Nursing, a for-profit institution that charges $35,000 for a one-year BSN program, says Dennis Krieb, director institutional research at LCCC.
At a hearing on legislation to permit community colleges to provide BSN programs, hospital officials complained they don’t have enough qualified RNs, while officials from university programs opposed the measure, claiming that they can fill the need.
“We argued that if that were the case, the need for the 80 percent goal would not be an issue,” Chapman says.
Because community colleges are the pathways for many students of color and first-generation college students, they are the institutions that are in the best position to provide advanced educational opportunities for nurses, he says.
Universities are over capacity and are turning applicants away, Krieb noted. Due to Illinois’ budget troubles, universities can’t expand their nursing programs, while LCCC already has the facilities in place plus a $1.3 million endowment for its nursing program.
A recently completed study conducted by EMSI for LCCC estimates 5,100 working nurses will want to go back to school to complete a BSN, and 93 percent of nurses with an ADN would prefer to go to a community college to continue their education.
“If they want to be employed, new students will need a BSN,” says Chapman. “Even if nurses have lots of experience, they too will need a BSN if they want to advance in their careers.”