Our healthcare system is increasingly requiring a more educated workforce to meet the demands of an aging and sicker patient population, an influx of advanced technology, care moving into the home and community and the advent of healthcare team configurations. Nurses, as the largest segment of the healthcare workforce, can play a critical role in providing patient care and care coordination across the healthcare continuum. Yet, far too few nurses receive the advanced degrees and additional training to enable them to better respond to these complexities. That’s why the landmark Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health (the “IOM report”), calls for academic nurse leaders across all schools of nursing to work together to increase the proportion of nurses with a baccalaureate degree from 50 percent to 80 percent by 2020. One promising innovation for ensuring that the United States attains this goal is for community colleges to grant 4-year baccalaureate degrees in nursing on their campuses.
The Problem: Why More Nurses with Baccalaureate Degrees Are Needed
Unlike other health professions, the nursing profession offers three different educational pathways to entry-level practice: the associate degree (AD), the bachelors of science in nursing (BSN) and the diploma in nursing. In 2008, 60 percent of nurses received an AD at community colleges, 36 percent received a BSN degree at 4-year degree-granting colleges and universities, and 3 percent received a diploma degree through hospital-based programs. Community college students who want to attain a BSN generally need to transfer to a 4-year degree granting school.
The BSN degree best prepares nurses for the major changes in the health care system and practice environments, according to the IOM report. BSN programs emphasize liberal arts, advanced sciences and nursing coursework across a wider range of settings than AD programs. They also expose students to leadership development and community and public health. This is crucial as care moves into the community. Furthermore, the BSN degree offers nurses a foundation for taking on more complex roles such as managing chronic illness, coordinating care, serving as primary care providers and taking on leadership roles.
Most important, nurses with BSN degrees are much more likely than AD nurses to attain advanced degrees. While nurses whose initial degree is an AD are just as likely as BSN-prepared nurses to seek another degree, 80 percent of the time they fail to complete the degree (Aiken 2009). This lack of educational progression has major ramifications for meeting future healthcare needs. Nurses with advanced degrees are helping to address the primary care shortage, especially as fewer medical students choose to enter primary care. With 32 million Americans scheduled to gain health insurance in 2014 under the Affordable Care Act, we need to make sure that there are enough providers to serve patients. The growing use of nurse practitioners has helped to ease access bottlenecks, reduce waiting times, increase patient satisfaction and free physicians to handle more complex cases (Cunningham 2010). Nurse practitioners also practice in rural areas and at community health centers, where fewer physicians practice.
In addition, nurses with advanced degrees are essential to increasing nurse faculty ranks. Each year, thousands of qualified students are turned away from nursing schools due to the limited faculty available to teach them. As a result, fewer nurses are available to meet increasingly complex health demands. Policies are needed to ensure that we accelerate educational progression so that the nursing workforce is able to address the challenges facing our healthcare system.
One Solution: Community Colleges Offering 4-Year BSN Degrees
The Florida College System, which encompasses the state’s community college system, has embarked on a truly innovative solution that has the potential to lead to transformational change in nursing education: offering BSN degrees on 14 of its community college campuses. As a result, more nurses are able to achieve higher levels of education through an improved and seamless academic pathway. Florida’s community colleges began offering the degrees after the state legislature questioned why the Florida College System could not help close workforce gaps by going beyond ADs to produce graduates with baccalaureate degrees in defined shortage areas, including nursing.
Since community colleges already educate the majority of nursing students, they have the potential to become a major producer of BSNs if they are able to offer BSN degrees on their campuses. Community colleges offer a wider geographic reach, moderate costs, diverse student bodies and a large infrastructure. They enable nurses with ADs to continue working while pursuing a higher degree. Jean Wortock, dean and professor of nursing at St. Petersburg College, believes her school’s BSN program is opening up an important channel for Florida nurses to advance their education in a state where 46 percent of qualified applicants to BSN programs were turned away in 2009 (The Future of Nursing: Leading Change, Advancing Health 2010). The BSN programs have tended to target and attract time- and place-bound students who might not otherwise pursue a degree at a 4-year college or university due to varying personal constraints, according to the Florida College System.
Florida community colleges work closely with the institutions within the public university system to develop BSN programs. St. Petersburg College, for example, collaborated closely with the University of Southern Florida (USF) to determine the degrees each institution would offer, enabling USF to focus more on master’s programs. As a result, both schools are maximizing the number of students who can be educated. Florida is also building its AD nursing programs to address the state’s nursing shortage, even as it expands its BSN programs.
For far too long, the nursing profession has engaged in divisive debates over whether the AD or BSN degree is preferable. As a profession, we need to realize that both have value, but that education progression must take priority. We need to get as many new nurses through the pipeline as quickly as possible, and community colleges offering BSN degrees is an excellent way to do that. We should pursue other strategies as well, including distance learning and simulation technologies, partnerships between educational institutions and clinical organizations and more collaboration between community colleges and universities to ensure that we meet the IOM report’s goal of increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
The future healthcare needs are acute, and the nursing profession needs to do its part to enhance its skills and capabilities to ensure that all patients receive exceptional care. By enabling nursing students at their campuses to receive BSN degrees, Florida’s community colleges are leading transformational change within nursing education that community colleges in other states should replicate. Florida’s community colleges are promoting educational progression so that more nurses are able to fill roles in primary care, public and community health and teach the next generation of nurses, as well as better preparing new nurses to meet the challenges of our healthcare system. In short, Florida’s community colleges are helping to ensure that all Americans have access to high-quality, patient-centered care in a healthcare system where nurses contribute as essential partners in achieving success.
Susan Hassmiller, PhD, RN, FAAN, is Senior Advisor for Nursing, the Robert Wood Johnson Foundation.
Aiken, L.H., R.B. Cheung, and D.M. Olds. (2009). Education Policy Initiatives to Address the Nurse Shortage in the United States. Health Affairs 28(4): w646-w656.
Cunningham, R. (2010). Tapping the Potential of the Health Care Workforce: Scope of Practice and Payment Policies for Advanced Practice Nurses and Physician Assistants (background paper no. 76). Washington, D.C.: National Health Policy Forum.
The Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health . Washington, D.C.: The National Academies Press (prepublication copy). Available at: http://www.nap.edu/catalog/12956.html.