Journal of Nursing

Nursing Demand Is Up, But So Are Standards


by Kate Howard Perry

Demand for nurses is growing, but nursing educators say the message is clear: An associate degree is no longer enough.

A two-year degree in nursing is still the minimum requirement to become a registered nurse in Nebraska. But for years, nursing institutes and medical studies have called for the deeper preparation that nurses receive when they earn a four-year degree that results in the same license.

As a result, the College of St. Mary this fall accepted its last class of students seeking an associate degree, phasing it out in favor of a new fast-track bachelor's degree program. Leaders at the college say they are listening to what the workplace is saying: It needs more baccalaureate-trained nurses.

Although the state doesn't mandate a bachelor's degree, some health care facilities in the region and around the U.S. do, said Kathleen Zajic, chairwoman of the Division of Health Professions at the college.

“We want our students to be marketable, to graduate and get a job,” she said.

Theresa Buse, who finished her associate degree at St. Mary in 2012, is working as a charge nurse at a skilled-care facility while she finishes her bachelor's. Finding a job at a hospital is next to impossible for her right now, she said. If the option of a three-year bachelor's existed when Buse first enrolled at St. Mary in 2010, she said, she may have taken it.

“Unless you already have a foot in the door, they want experience and they want your bachelor's degree,” Buse said. “Ultimately, if I want to work in a hospital, I'm just going to have to wait.”

Currently, the only way to get a bachelor's in nursing at St. Mary is through its “RN to BSN” program, open to those who are already registered nurses holding an associate degree.

The new program will be a three-year, year-round program in which students, starting as freshmen, take clinical and practical classes during the fall and spring semesters and take core degree requirements in the summer to earn a Bachelor of Science in nursing.

The year-round courses will end up costing about 17 percent less than four years of tuition would, according to the college, but students will have the option of taking the program over four years.

Getting jobs in the Nebraska health care industry is getting harder despite the demand, employers and job seekers say.

The current staff at the Visiting Nurse Association has a mix of education levels, said Bridget Caniglia, vice president of home care. An individual applicant's experience is always a consideration, Caniglia said, but as the VNA fills open positions, it is almost always looking for a bachelor's degree.

“We've had phenomenal associate-prepared nurses, but in home care, the kind of health issues we face now are a lot bigger than what a bedside nurse might handle,” Caniglia said.

Alegent Creighton Health plans to require bachelor's degrees in new hires at its hospitals starting in 2018, said Kevin Schwedhelm, chief nursing executive at Bergan Mercy Medical Center. Nurses hired now with associate degrees know they are expected to continue their education, Schwedhelm said, although some later-career nurses will be grandfathered in.

“There is just a changing focus, from health care to keeping our communities healthy,” Schwedhelm said. “We just need a more well-rounded nurse.”

When the last students in the two-year program graduate from the College of St. Mary, only the community college system and for-profit colleges in Nebraska will continue to offer an associate degree in nursing.

At Clarkson College and Nebraska Methodist College, colleges in Omaha that prepare students for health care professions, an associate degree was never offered in nursing. When the colleges moved from offering diploma programs to becoming degree-granting institutions, they went straight to bachelor's degrees.

It was a decision made almost 20 years ago that is proving wise now, said Aubray Orduña, dean of nursing at Clarkson College and a member of the executive committee of the Nebraska Action Coalition, focused on improving nursing education.

A report issued by the Institute of Medicine three years ago called for more baccalaureate-educated nurses in the workforce. Its goal was to increase the percentage of nurses with bachelor's degrees from 50 percent to 80 percent by 2020.

Orduña said Clarkson and other colleges have been working together to streamline their requirements for RNs coming into bachelor's programs, so working professionals know exactly what is required to take the next step.

Community colleges will continue to offer the associate degree in nursing as a gateway to the profession and many entry-level jobs, said Stacey Ocander, dean of health and public services at Metropolitan Community College.

“Both community colleges and four-year institutions need to prepare more qualified nurses to meet the nation's growing demand for health care and to replace a wave of nurses getting closer to retirement,” she said.


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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer