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College partnerships can combat ‘degree creep’ in nursing

Betty Young
​ORLANDO, Fla. If community college leaders want to succeed in the fight against “degree creep” in nursing and other allied professions, they need to become actively engaged with other health education groups.
That was the key message at a session at the American Association of Community Colleges (AACC) annual convention on how community college leaders can counter mandates requiring bachelor’s degrees for nurses.
The major forces pushing the bachelor of science in nursing (BSN) mandate are the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation, which have recommended that 80 percent of nurses earn bachelor’s degrees by 2020, said Betty Young, president of the John B. Coleman College for Health Sciences at Houston Community College and the Texas Medical Center.
While registered nursing programs are at the forefront of the degree-creep movement, other allied health professions also are affected, including physician assistants, dental hygienists, physical therapists, respiratory therapists, occupational therapists and nuclear medicine technicians, Young said.
Magnet status
Among the factors pushing for degree creep cited by Young include: the well-funded BSN lobby, which is encouraging states to require ADN-educated nurses to earn a BSN within 10 years; a growing number of employers that are giving a hiring preference to nurses with BSNs; and the push by hospitals to achieve “magnet status.”
The magnet designation, conferred by the American Nurses Credentialing Center, recognizes hospitals for having good safety and outcomes for patients and good working conditions for nurses. According to Young, there is a lot of misinformation about the magnet designation. Only 7 percent of hospitals have achieved magnet status, and these institutions have “half the diversity of other hospitals,” she said.
Michael Brown, regional president and CEO of Provena Health-Resurrection Health Care at United Samaritans Medical Center and Covenant Medical Center in Illinois, said the push for hospitals to achieve magnet status is more of a “recruitment ploy” and an effort to boost their image than it is about the quality of health care.
Th BSN movement is a “great threat” to community college nursing programs, Young said, noting that hospitals are denying clinical space to ADN programs. The greatest indicator of high-quality nursing care, is “not the degree. It’s the number of nurses employed to care for you,” she said.
The critical finding from a 2010 IOM report calling for an increase in the number of BSN-educated nurses is that “there is no causal relationship between the level of education and patient outcomes,” said Donna Meyer, president of the National Organization for Associate Degree Nursing and dean of health sciences at Lewis and Clark Community College in Illinois. All nursing students take the same licensing exam, no matter where they were educated, Meyer said. She added that a mandate requiring a BSN would be a hardship for students who can’t afford the higher tuition at a four-year college.
According to Brown, a patient can’t tell the difference between an ADN-educated nurse and a nurse with a master’s degree. He called it a “huge error to take those who are good at providing bedside care and turn them into managers."
The Robert Woods Johnson Foundation has created 48 state-level coalitions to push the BSN agenda. Meyer urged community colleges to pay attention to policy discussions going on within those coalitions and other organizations, such as the National League for Nursing and the American Association of Colleges of Nursing, and make sure the community college perspective is heard.
“We have to be very attuned to what is happening,” Meyer said.
A seat at the table
Carolyn O’Daniel, president of the National Network of Health Care Programs in Two-Year Colleges and dean of allied health and nursing at Jefferson Community and Technical College (Kentucky), urged community college leaders to push for institutional memberships and encourage faculty to get involved in health organizations where community colleges are underrepresented. 
“We need to ensure community colleges are not overlooked in these discussions,” she said.
Another proactive step taken by community college leaders cited by O'Daniel was the creation of the National Network for Associate Degree Respiratory Care in 2010 to advocate for community college programs for educating respiratory therapists.
Two-year college leaders also are beginning to discuss the establishment of a health-care core curriculum “as a vehicle for interdisciplinary partnerships to break down the silos and help us ensure consistency,”  O’Daniel said. This concept would promote the efficiency of scale provided by community colleges and allow students to learn basic safety principles before they head into separate tracks.
Colleges also should leverage their relationship with employers to speak on their behalf.
“The relationship you have with employers is hugely important,” added Brown. They can help community colleges attain grant funding and support career pathways, he said.
Advocacy is crucial
AACC is engaged in the effort to combat degree creep and strengthen the ability of community colleges to educate nurses, said Roxanne Fulcher, director of health professions policy at AACC. ​Among the steps AACC is taking:
• The association produces a series of factsheets that outline the value of ADN and dispell myths about nursing education
• AACC has published papers refuting the IOM findings and the misperceptions about the meaning of magnet status
• Community college leaders are speaking out at meetings on health education to refute incorrect statements on the data and promote the strengths of community college nursing programs: they serve diverse populations and rural areas, and they are interdisciplinary, flexible and innovative.
• AACC leaders are advocating against mandates, such as a proposal in New York to require nurses to earn a BSN within 10 years.
“If that mandate is enacted, we will see a domino effect,” Fulcher said.