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Diagnosis: Nurses Should Never Stop Learning

Studies show nurses may be in need of education beyond an associate degree.

By Sarah Nemeth and Donna Meyer, NOADN president and Dean of Health Sciences at Lewis and Clark Community College

One of the most fertile grounds for career changers these days is nursing, with current practitioners considering furthering their education in hopes of better job prospects within the field. The options for entering the field, and for advancing within it, include certification, associate, baccalaureate and graduate degrees. In today’s economic slump, some nurses are seeking higher degrees in hopes of more opportunities with higher salaries.

Trends have shown that most nurses finish their academic pursuits with an associate or baccalaureate degree. A small minority—about the same percentage for each—end up with a diploma or graduate degree. Data from a 2008 report done by the Health Resources and Services Administration of the U.S. Department of Health and Human Services indicates that of the 2.6 million registered nurses working in the United States, 1.18 million entered the field with an associate degree in nursing. Slightly more than 889,000 initially got a higher degree. That trend has continued since 1980, according to the report.

Voices like the American Nurses Association, the National Advisory Council on Nurse Education and Practice, the American Association of Colleges of Nursing, and the American Organization of Nurse Executives lean toward a baccalaureate degree standard for nursing. Others, such as the National Organization for Associate Degree Nursing, do not see the lines falling against associate education.

“I don’t think it's a push in that direction,” said Donna Meyer, NOADN president and Dean of Health Sciences at Lewis and Clark Community College. “It's an opportunity for many individuals to get their first nursing degree. Five years ago we were really in the midst of a huge nursing shortage. It's coming again.

*We have encouraged people for academic progression. We are presently encouraging students to continue their education.”

“We are trying really hard to be united and work together. I think that's the way we're going to succeed in nursing in this country is to work together.” - Donna Meyer, NOADN President

Training comes in many forms

Meyer said those taking the associate degree route are tested on the same things as those seeking a baccalaureate degree.

“The [National Council Licensure Examination] pass rate compared to [the Bachelor of Science in Nursing degree] has always been very comparable,” she said, adding that earning an ADN requires far less time and money.

Another option that some nurses are taking is starting with an associate degree and going back to school for a master’s degree in nursing, opening doors to nurse practitioner careers. Meyer believes more nurse practitioners and nurse educators will be needed in the near future.

“I think when we talk about advancing education we think it's important because there's more opportunities then as you advance your education,” she said. “I think education is a benefit to begin with.”

Devil in the Details

But there are also grave reasons behind the need for a well-educated nursing workforce. An Institutes of Medicine report from 1999 indicated that up to 98,000 patients die each year due to medical error in the United States. This is mostly because of problems with the care system and process, wrote Liana Orsolini-Hain, in an article for the National Student Nurses Association. Orsolini-Hain is a registered nurse and a nursing professor at the City College of San Francisco who recently researched trends in nursing education. She declined to be interviewed for this article, citing a conflict with a fellowship she is currently participating in.

The medical errors could be an indication of a need for more advanced nursing education, Orsolini-Hain stated.

“It would seem that BSN and higher educated nurses are prepared the best to implement solutions because the curriculum emphasizes leadership and management,” she wrote in the article. “In the years following the IOM report there has been a renewed call for either a higher percentage of BSN prepared nurses or for making the BSN entry level into nursing practice.” Meyer is not sure that is the case.

“I think there's only limited amount of research ... [which is] inconclusive at this time,” Meyer said of the patient mortality data. “There has also been research that has shown that there is not a correlation. I think more research needs to be done. I think what needs to be looked at is the staffing ratio. The number of nurses caring for patients can directly affect patient outcomes.”

Many Paths Lead to the Credentials

Further findings from the HRSA report show how nurses in America prepare for their career. Of those surveyed, 14 percent initially earned only a diploma; while 36 percent earned an associate degree; 37 percent earned a baccalaureate degree; and 13 percent earned a graduate degree. The data does not change much for the highest degree earned. Of those surveyed, 12 percent never earned more than a diploma; while 38 percent had earned an associate degree only; 37 percent, a baccalaureate degree; and 13 percent a graduate degree.

Obstacles for RNs who would like to further their education include accessibility, finances and national economic woes, Meyer said.

“I think accessibility to RN to BSN or RN to MSN online formats is still a significant obstacle. Rural areas and even not so rural areas often lack high-speed internet capabilities, leaving nurses in these areas without an option for advanced nursing education. Finances are also a limiting factor for many nurses. Some of the hospitals are still trying to pay tuition reimbursement, but we're talking about economic issues right now in health care. Unfortunately, sometimes they might have to [offer less] nursing education reimbursement.”

Have an Exit Strategy

Once a graduate has a degree—whichever one they earn—landing a job can be a challenge. Meyer suggests a few ways to boost the chances of securing employment soon after college. “If they can possibly get their foot in the door before they graduate is number one, depending on what area of the country you're in either a student nurse role or a certified nurse’s assistant,” she said. “The other thing is I think that nursing graduates need to think nursing is not just being in the hospital anymore, especially with health care reform. They have to be more flexible.”

When deciding on an advanced educational path in nursing, Meyer suggests setting up a plan B. “My advice to anyone ... look at a [master's] program that has an exit for a BSN,” she said. “You know, life happens. You want to make sure that you have that opportunity to maybe step out and have that BSN. I feel like as a dean of a program, if I was advising a student, I'd say make sure you ask those types of questions.”

Meyer suggests looking into community college nursing programs for nursing associate degrees, but supports the need for educational advancement.

“I think as much as possible you always want to encourage people to continue their education,” she said. “I think the door's open to them.

“We are trying really hard to be united and work together. I think that's the way we're going to succeed in nursing in this country is to work together.”

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