Apparently it is the silly season in nursing education

Inside Higher Ed reports on a new study from the Carnegie Foundation for the Advancement of Teaching that calls for the bachelor of science in nursing (BSN) to be required for entry into the field of nursing. The authors of the study are correct in stating that the demands on nurses are increasingly complex. In their report they state that “nurses and nursing students must function within the complicated, and many would say, chaotic and dysfunctional U.S. health care system.”

But what they propose is just plain silly; self-serving but still silly. They describe ongoing nursing shortages, saying that the growing shortages caused “93% of hospital-based registered nurses to report a lack of sufficient time and staff to maintain patient safety, detect complications early, and collaborate with other health care team members.” I am not at all sure how they conclude that this is a problem to be solved by education but the idea of increasing the barriers to practice nursing by requiring a bachelor’s degree seems counter-productive at best. This is further evidence that not only is health care dysfunctional but so are the politics of nursing and nursing licensure.

What really irritates me about this piece is that the authors attack (though they insist that is not really what they are doing) the associate degree in nursing (ADN) and the colleges that offer these programs, many of them community colleges. Patricia Benner, one of the authors, is quoted as saying such a change “would hold community college nursing programs more accountable.” That “the minimum amount of time a student has to spend in these ‘two-year programs’ is actually three years.”

Fortunately, Kim Tinsley of North Arkansas College and a member of the National Organization for Associate Degree Nursing pointed out that “I teach in a rural setting and the main advantage of offering a two-year RN degree is that it puts the nurse graduate to work in a shorter amount of time so they can support their family. They cannot afford four years of BSN classes and not work. The ADN student does sometimes have to take up to four years to complete their degree but it is due to the fact that they are working (sometimes full time) and have a family to support. The average age of our students is 27. The majority of our students are either married with a family or are a single parent. They cannot afford the time nor resources to attend a four-year program.”

Thanks to Ms. Tinsley. What her statement lays out clearly is that this is not just an attack on a type of degree but on the people who most often pursue that degree—the other 85%. The students in the ADN programs are older. Rather than being financially dependent on their parents, they more often have families of their own who depend on them. And, whether a family or not, they are often working.

Let’s be honest here. Schools like those that the authors of this report work at are not willing or able to serve the audiences that attend the ADN programs. The authors say that these BSN schools would need to “increase capacity by approximately 90 percent.” Is that likely to happen during a recession? Absolutely not and it would not happen during the best of economic times. That is because BSN programs at research universities use the undergraduate programs as feeders for their graduate programs. They want traditional students who compete for entry into elite programs. They don’t want to serve the folks in the ADN programs because the students in these programs don’t fit the mold and some, if not many, of these students might require remedial assistance. The fact is that there is a racial and class overlay here that is just below the surface. Community colleges and other ADN providers are serving a far more racially diverse audience than the BSN schools as well as many low-income students.

The authors claim that they are not opposed to the community colleges and their suggested change might lead to better articulation agreements. Yes, when hell freezes over. All we need to do is to look at the current state of such articulation agreements nationally to have one more proof point that schools like the ones the authors are defending remain elitist and are not interested in seriously getting at the fact that it is the diverse and low income students who are earning ADN degrees and becoming registered nurses. These nurses are holding our health care system together and there is no way that a group of BSN nurses admitted under current admissions standards that are intended to limit access will ever replace them.

The truth is that this call is about getting more funding for the BSN programs. Any call for continued elitism and raising barriers to entry in a profession that is suffering serious shortages is just plain silly.

I encourage you to share your thoughts.

Mike