Academic/Professional Progression in Nursing
September 2007 The debate about the most appropriate preparation for nursing practice has raged in nursing for the past 40 years. The National League for Nursing has long championed the nursing professions multiple entry points. With our proud tradition as the national voice for all nurse educators in all types of nursing education programs, the NLN does not wish to spark that debate again.But proposed legislation in New York, New Jersey, and other states has revived the question of educational preparation for nursing practiceand how to approach lifelong learning for all nurses, regardless of their initial level of preparation. Our mission, goals, and history position us to be a catalyst for the exchange of ideas about this important issue that will have profound effects on nursing education, the ethnic/racial diversity of our nursing workforce, access to health care, the cost of health care, and public policy. The State Proposals
The proposals under consideration require nurses prepared in diploma or associate degree programs to obtain a baccalaureate degree in nursing within 10 years of initial licensure. The current proposals are viewed by some organizations as a continuation of the old argument for the baccalaureate degree required for RN licensure. Others view the proposals as a bold move to respond to health care workforce needs. - Provisions to grandfather all currently licensed RNs and to waive the requirement for the baccalaureate degree for students enrolled in or on a waiting list for admission to an RN program are included.According to the bills proponents, because the proposals do not affect current nurses or nursing students, they will not intensify the nursing shortage we face today.
- Nurses who enter nursing programs after the legislation is passed who do not meet the requirements will have their licenses put "on hold," a practice currently in place for licensees in other professions (e.g., teachers in New York State).
- An extension beyond the 10 years is provided for extenuating circumstances.
Considerations - Nurses must be able to practice as peers with other health care professionals and integrate evidence-based clinical knowledge and research with effective communication and leadership skills. Other professions, including physical therapy, occupational therapy, pharmacy, and physician assistants have raised their preparation for practice credentials, citing a need to respond to the increasing complexity of the health care system. And, although the nursing shortage is a global issue, countries including the Philippines, Australia, France, Germany, and many Canadian provinces do require baccalaureate education as a minimum credential for registered nurses.
- There is a growing consensus among nurse educators, legislators, and colleagues in service that our current system of nursing education has not provided enough opportunities and incentives for associate degree and diploma program graduates to pursue baccalaureate and masters education, and for baccalaureate graduates to obtain advanced degrees. Most recent statistics (National Sample Survey, 2004) reveal that about 20.7 percent of those initially educated in associate degree programs and 30.2 percent of those prepared in diploma programs had obtained post-RN nursing or related degrees. Fewer than 22.1 percent of graduates prepared initially in a baccalaureate program had obtained post-RN degrees. In many cases, RN students are required to take additional prerequisites, repeat rather than build upon courses they have already completed successfully, and engage in learning experiences that may not help them differentiate the role of an academically advanced-prepared nurse.
- Health care settings must be willing to provide support - both financial and scheduling - to help their employees access and successfully complete a baccalaureate, masters, or doctoral program. To remain competitive in recruiting and retaining nurses, employers must provide nurses with work schedules conducive to school schedules and offer tuition reimbursement and/or loan repayment options. The means to financially reward professional progression should also be explored. Such models reflect AONEs position that there must be collaboration among nursing education, practice, and research to improve patient care delivery models and advance the education of nurses.
Recommendations - The development of more efficient pathways to higher degrees is essential before nurses in large numbers will make the choice to pursue an advanced degree.
- A critical goal for the future must be to sidestep the old argument of baccalaureate entry and move to options, such as RN to BSN or RN to MSN, that are not based on entry but as opportunities for lifelong learning and progression for those who enter the nursing profession through diploma and associate degree programs. This will help the nursing profession to practice effectively in a health care environment that includes shorter hospital stays, higher patient acuity, increasing numbers of older adults with multiple chronic conditions, rapid technological advances, and proliferation of drug therapies.
- It is essential that the nursing profession take fullest advantage of the diversity offered by multiple points of entry into the profession and the variety of progression options available , and encourage all nurses (regardless of initial preparation) to continue their education.
- Clear and fair articulation agreements between associate degree and baccalaureate and masters programs that a) are not repetitive of nurses previous education and experience, b) are accessible and flexible in terms of where and how they are delivered, and c) allow for individualized learning, must be developed.
- The ability of nursing practice settings to provide appropriate clinical learning experiences must be addressed. And ways must be found to expand the capacity of baccalaureate and masters programs to accommodate all RNs who would be required to earn the advanced academic degree (e.g., through online programs).
- As many Americans are finding higher education less accessible financially, the cost of financing additional education must be tackled. Nursing’s work with our government – nationally, state-wide, and locally – must be politically addressed using the power of 2.9 million nurses.
- Nurse educators, public policy and workforce experts, health care organizations, and all other interested parties must transform the dialogue from entry into practice into progression within the profession. We must address how our schools of nursing can graduate a nursing workforce that meets current and future demands for quality and safety. We must respond with new programs and pathways or risk a future that is reactive, rather than strategic and intentional.
Colleagues, these are our thoughts at this point, please join us in this dialogue and of course, the reflection… - How will we inspire graduates of associate degree, diploma, and bachelors degree programs to continue their formal nursing education, to expand leadership and communication skills in an increasingly complex health care system?
- What incentives will encourage nurses to attain additional formal credentials, as well as value lifelong learning and continued professional practice?
- How can we think creatively about articulation and build seamless transition models that incorporate flexible scheduling and convenient meeting places, that provide opportunities for diverse nursing graduates to pursue individual interests, and that do not repeat nurses previous education and experiences?
As befitting our history, the NLN welcomes the opportunity to open this discussion.
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