Is it Time for a Two-Track Nursing Education System?

In what may be news to most people, a March 6, 2016 Wall Street article “Colleges Lock Horns Over Nursing Programs-Four-year institutions try to prevent community colleges from offering advanced programs” states:

The Institute of Medicine, now part of the nonprofit National Academy of Sciences, in 2010 recommended that 80% of nurses hold bachelor’s degrees by 2020, up from about 50% at the time.

Spurred by the report, as well as incentives in the Affordable Care Act to use more highly credentialed nurses, hospitals are scrambling to bring on new staff with bachelor of science degrees in nursing, or push nurses with associate degrees to upgrade to a BSN. That means additional coursework emphasizing community health, critical thinking and evaluating research, in addition to liberal-arts or general-education classes….

That means nurses like Kristina Spaete, who landed a job as a surgical nurse at Scripps Mercy Hospital in San Diego after completing her associate degree in nursing at a community college last May, could soon find herself back in school.

“I feel selfish if I were to go back and pay a ton of money for school,” said the 35-year-old mother of three, who is hoping she can get a BSN at a community college.
For now, getting into any program is tough. U.S. schools turned away 68,938 qualified applicants from bachelor’s and graduate nursing programs in 2014, according to the American Association of Colleges of Nursing, citing a dearth of faculty, clinical sites and classroom space.

Leaders at community colleges, which now train nurses to the associate-degree level, argue they can help fill a hole in the nursing labor market at a low price. Administrators at four-year colleges counter that community colleges aren’t equipped to teach upper-level nursing courses and say there aren’t enough qualified faculty to go around.

“We have to be responsible in terms of how many students realistically can complete these programs, and how many can get jobs,” said Christine Mallon, assistant vice chancellor of academic programs and faculty development at the California State University System.

Here is the letter to the editor I sent to the Wall Street Journal about the crisis in nursing education.

In 1969, I graduated from one of the first associate degree nursing programs due to limited funds and an intense desire to start my nursing career. Some of my high school classmates chose a 4 year BSN degree but the vast majority of nurses then were three year hospital diploma nurses. Now there are almost no diploma programs which were then considered the “gold standard” for nursing education.

At the time, I felt I received a great nursing education but I also felt I needed more clinical experience so I went to the only hospital in my area to offer a nursing internship. I spent the next year in different divisions: 3 months each on medical and surgical divisions including ICUs, 3 months in operating rooms and 3 months as an elective in the cardiac ICU.

By the end of that year, not only did I gain an enormous amount of knowledge and confidence but I also was able to make the decision that I wanted to be an ICU nurse able to work in any type of ICU. I did achieve my dream and more.

A few years after working, I decided I wanted to learn more and I signed up for a BSN completion course at my own expense since scholarships were few and far between. However, I was disappointed that the program seemed geared to producing administrative nurses rather than clinical nurses. I wanted to be a great bedside nurse so instead, I took courses in music and considered pursuing an economics degree to give me more options.

But now, only a BSN will protect many fine nurses from termination or even finding employment at the beginning of their careers. In addition, the shortage of good, reasonably priced BSN completion programs will probably deter many people from even considering a nursing career.

I propose a 2 track nursing education system.

Those who want to be a great bedside nurse could obtain an associate degree and complete a year of internship as a kind of apprenticeship. This plan would not only give new nurses the support to take on the challenges of a bedside nursing career but also help them discover what kind of nursing fit their capabilities best. Such nurses could advance by becoming certified in their chosen specialties. A BSN completion course would always be available if wanted but not required as it is in many health care institutions today.

Some students would choose a BSN program from the beginning but might also want access to the support of an internship when they begin their nursing careers.
I believe this would produce the dedicated nurses we need both at the bedside and in administrative roles.

And after almost 47 years in nursing after following this plan, I would still choose this career again.

I would like to hear what you think or what ideas you have, especially if you are a nurse yourself!

2 thoughts on “Is it Time for a Two-Track Nursing Education System?

  1. Thank you for your column.I graduated from community college in 1990.I was a late starter,adult student and was 30 years old upon graduating and received my “entry level” R.N.
    My community college had a much higher “pass rate”( for the RN board) than the very expensive, four year program that was offered in my area.
    There was no contest, since I was on my own dime.
    There has been a “two tiered” system in place since WWII.
    Thank goodness,I’m grateful because I have been able to carve out a fantastic RN career with “just” an associates. I’ve felt the pressure for decades to climb the education ladder.It hasn’t been practical for me.
    I’ve lived within this “caste system”,for decades and have, been of help, to my profession.
    I have seen very dedicated young Nurses continue on with their education and get further and further away from the “client”.It’s a very mean “game”,in that respect, if they want to stay in clinical,some are made to feel they are “under achiever’s” unless they get their, “NP”, quite a different focus.
    I have been told by a (newby) BS that an AAS.,RN is to a BS RN,what an LPN is to an RN,
    I suggested that,power to you, that perhaps someday, you will be my H.N.or N.M. as opposed to me being the A.H.N. but for the time being,this is the schedule …(punk kid 😀 !)

    I would suggest if a new student can afford it,(or their parents )it’s easier to combat the never ending education “push”,….
    if you enter with your BS.
    If indeed you can’t afford it,most employers have pathetically long reimbursement options towards the degree, and you are pressured less, for being a “second class” RN if you are ,at least ‘enrolled”,in a BS program.
    I am not far from retirement and have been very blessed.I’m thinking about taking an Art degree.


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