Looking ahead to 2020-2030, a new National Academy of Medicine report recognizes the contribution of community colleges to the nursing profession, describing them as an important workforce pipeline, more affordable than four-year public institutions and serving a high percentage of non-white individuals.
As evidence of this role, community colleges conferred 75% of all associate in nursing (ADN) degrees in 2019-2020.
The Academy said in a 2011 report there was a need to transform nursing education that put greater focus on baccalaureates and promoted seamless academic progress. The prevalent path to become a registered nurse then was through an ADN and passing the NCLEX-RN examination required for licensure. In 2011, 57% of first-time candidates who passed the NCLEX exam held ADNs, compared to 40% with bachelor of nursing (BSN) degrees.
The American Association of Community Colleges (AACC), together with five other organizations, including the Association of Community College Trustees, issued in 2012 a joint statement in support of “a well-educated, diverse nursing workforce to advance the nation’s health.” In promoting the seamless academic progression in nursing education, AACC stressed the importance of an associate degree in that process.
Current nursing education landscape
Providing pathways to further education and careers is a core mission of community colleges. Exemplary of this is their adoption of the RN-to-BSN approach to academic progress. This is no small feat as legislation is required to allow community colleges to offer baccalaureate programs. There are now more than 70 community college BSN programs in 16 states.
The largest programs are concentrated in a few states and overall represent only a small percent of total nursing baccalaureates. Of the states with BSN programs, Florida ranks at the top with the most programs (38%) and largest number of BSN graduates (62%). Ohio is the most recent state to pass such legislation.
Nurses in the workforce
The Bureau of Labor Statistics’ 2020 Occupation Outlook Handbook indicates that a bachelor’s degree is a typical entry-level education for registered nurses, but two-thirds of employers (66%) require an associate nursing degree as an entry-level credential. Only 23% require a baccalaureate.
The entry-level designation aligns with the goal set by the first Academy of Medicine report to increase the nursing workforce holding a BSN to 80% by 2020. This goal has not been reached. Census Bureau data show that about 60% of the nursing workforce holds a BSN.
Toward equity in health
The new Academy report focuses on charting a path to achieve health equity. One of its recommendations is for a variety of entities, including federal and state governments, to take actions by 2023 that “enable the nursing workforce to address social determinants of health and health equity more comprehensively, regardless of practice setting.” Supporting academic progression for disadvantaged and historically underserved students is a listed action. It specifies encouraging partnerships among baccalaureate and high degree nursing programs and community colleges, historically Black colleges and universities, and minority-serving institutions (MSIs).
Community colleges, many of which are MSIs, already educate a disproportionate percent of non-white nursing students. Three-fourths or more of all ADN graduates who are American Indian or Alaska Natives, Asian and Latinx earned their degree at a community college. These colleges also conferred 60% or more of ADN degrees earned by Black students and more than half of Hawaii Natives and Other Pacific Islanders. Moreover, a substantial percentage of BSN earners at community colleges are African-American (14%) and Latinx (15%).
Community colleges also serve their communities in other equity-focused ways. Community colleges set up pop-up Covid vaccination clinics for their students and communities with First Lady Jill Biden visiting a couple. There are many examples of community colleges across the country providing free healthcare clinics in their communities with high numbers of low-income people.
Community colleges also provide free or reduced-price health care on campuses in rural communities. Many rural areas lack adequate healthcare, whether because of hospitals have closed or are very distant or have many un- or underinsured who cannot afford healthcare.
Another example of community college involvement in fostering equity in health is AACC’s support for the bi-partisan Pathways to Health Careers Act (H.R. 4449) that would expand the Health Profession Opportunity Grant (HPOG) Program, which is in its final year of funding. HPOG is currently a demonstration program involving 32 programs in about 20 states. Under the new legislation, all 50 states, U.S. territories and tribal communities would be eligible for HPOG programs. These offer career pathways to in-demand healthcare occupations, including nursing, for low-income individuals, such as TANF recipients.