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.