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Nursing students at Metropolitan Community College in Nebraska.
Despite all the talk about “degree creep”—the push toward requiring a bachelor’s degree as the entry-level for registered nurses (RNs)—associate degree nursing programs at community colleges remain strong.
Many colleges are forging new partnerships and articulation agreements with four-year colleges to help their students advance. Yet, some colleges are finding their students are already being shut out of hospitals.
Accrediting bodies have not abandoned the associate degree in nursing (ADN), noted Thomas Snyder, president of Ivy Tech Community College in Indiana.
“As long as accreditors recognize the ADN is adequate, it’s not going to change,” said Snyder, who chairs the National Council of State Directors of Community Colleges' Nursing and Allied Health Professions Workgroup. The council is affiliated with the American Association of Community Colleges.
State directors focus on nursing data to support ADN
The workgroup is exploring ways to strengthen community college healthcare programs and to counter misinformation being spread by some special interest groups that are encouraging hospitals to attain “nursing magnet” status by limiting employment to RNs that have bachelor’s degrees in nursing (BSNs).
While the degree-creep trend might not be easily reversed, it doesn’t seem to be gaining much momentum either.
“The progress being made is modest to say the least,” said Snyder, who noted that community colleges educate well over 40 percent of the nation’s nurses.
Starting with an ADN
According to Snyder, the push for at least a baccalaureate for nurses is based on an incorrect premise: that community college-prepared RNs are less capable. But none of the studies promoting magnet hospitals have data showing that nurses with BSNs provide better care.
Nurses with ADNs are passing the nursing boards at the same or better rate than nurses with BSNs, said Stacey Ocander, dean of health and public services at Metropolitan Community College (MCC) in Nebraska and president of the National Network of Health Career Programs in Two-Year Colleges (NN2), a group affiliated with AACC.
“We do believe in people continuing their education, but you have to start somewhere,” Ocander said. “We encourage students once they pass the boards to complete a BSN at a four-year college.”
“Starting with an 18-month LPN or CNA [certified nursing assistant] program is a wonderful opportunity for someone who never thought they could go to college,” added Barbara Jones, president of South Arkansas Community College (SouthArk) and a former president of NN2. An LPN can get a good job with benefits, and from there, it’s less daunting to pursue an associate degree, RN license and then a BSN.
A needed rung
Requiring a BSN would create a gap between the entry level and highest levels in nursing, Jones said.
“Nursing has a well-defined career track. Why eliminate one of the rungs of the ladder?”
“Many of our students are first-generation college students, so it could take six or seven years to finish a degree if they are working and raising a family,” Jones said. “Sometimes the only way they can do it is with the stackable certificates—the learn-and-earn concept.”
Nursing programs still face space, faculty shortages
Moreover, most hospitals don’t pay higher salaries to nurses with BSNs, Ocander said, so “why go into debt, when hospitals are not going to pay a differential?”
Faced with that situation, many students likely will choose different careers—and that could lead to workforce shortages.
Community colleges also need to encourage nursing students to continue their education to ensure an adequate supply of nursing faculty. That’s a huge problem, said Snyder, who noted that Ivy Tech has had to cut enrollment in nursing programs by 15 percent due to the shortage of faculty.
Clinical shortcomings hamper nursing ed
Some hospitals have already started to only hire nurses with BSNs, and hospitals all over the country—including two in Omaha where MCC is based—are refusing to open their doors to clinical experiences for community college students, Ocander said.
“We see this as shortsighted,” Snyder said. “It flies in the face of quality and economics.”
To counter that trend, Ivy Tech is expanding its investment in simulators. MCC has had to find less than ideal alternatives for clinicals, such as hospice care, extended care and respite care facilities.
Ocander thinks hospitals would want to host community college students for clinicals because it would motivate them to pursue a bachelor's degree.
“Ethically, how can hospitals say they won’t educate them? It is part of hospitals’ mission to provide service to the community,” she said. “They are discriminating against a whole class of people who have chosen a community college education.”
About 20 to 25 percent of MCC nursing students continue their education at Nebraska Wesleyan University, which automatically accepts their credits. Students who earn an ADN have already completed the core courses in nursing and the clinical requirements. So that means they only need to take a few more courses to complete a BSN at Wesleyan, a private liberal arts college that costs about $25,000 a year.
That kind of articulation arrangement—Ocander calls it “a beautiful marriage”—is better than the traditional 2+2 approach. At the end of the first two years, students in those program have only completed general education courses at a community college, so they don’t have an associate degree and are not employable.
“I truly believe the answer is the stackable credential and articulation agreements,” Ocander said.
Nursing students at Hinds Community College (HCC) in Mississippi can easily transfer to four-year colleges in the state with very few barriers, said Elizabeth Mahaffey, dean of nursing and allied health. HCC has an agreement with the University of Mississippi Medical Center (UMMC) giving students who complete an ADN guaranteed admission to an RN to master’s program.
UMMC’s 2+U program allows students who completed an associate degree in a health-related field, such as health informatics, dental hygiene or radiologic sciences, to get credit for some of the courses they’ve taken at a community college and work on a bachelor’s degree while staying in their community and taking online courses.
A similar program is starting this fall at SouthArk, which is part of a consortium of eight community colleges that have articulation agreements with several institutions that have BSN programs, Jones said.
Students who complete an ADN can pursue a BSN and a master’s degree in nursing at the University of Arkansas for Medical Sciences (UAMS)—without leaving the SouthArk campus in rural El Dorado, Ark. UAMS will send an adviser to SouthArk to help students navigate the system, Jones said. SouthArk is facilitating the program and providing classroom space, but the degrees will be from UAMS.
Controlling healthcare costs
Ivy Tech has the largest nursing school in the country—with 1,300 graduates a year. Many of them are working adults or single parents, Snyder noted. Requiring them to take another year of college would be a “massive cost to society,” to the tune of $20 million to $50 million a year.
Snyder predicts a strong push over the next decade to control healthcare costs and emphasize outcomes over cost. Requiring BSNs will increase state Medicaid costs without leading to improvements in healthcare.
“Adding to the cost with no definitive outcome is a mistake,” he said.
The most critical issue in healthcare quality is the ratio of nurses to patients—not the education level of nurses, Snyder noted. In fact, one could say nurses educated in community colleges actually provide better care.
“The average age of our graduates is 30," Snyder said. "They are more mature and have more family experiences than younger graduates, and that adds to the robustness of care.”
Copyright ©2014 American Association of Community Colleges