More Nurses Climbing Education Ladder

A more highly educated nursing workforce will help meet future health care demands.

    • April 15, 2013

Imani Baker is a young, aspiring nurse who knows what lies ahead: increasing numbers of elderly patients with multiple chronic conditions and a surging demand for nurses who can provide skilled care for them in various settings.

A recent graduate of Rutgers, the State University of New Jersey, Baker is preparing to meet their needs: She recently earned a bachelor’s degree in public health, completed a research project on the culture of nursing homes, and won the 2012 “Intern of the Year” award presented by Project L/EARN, a program supported by the Robert Wood Johnson Foundation (RWJF) that helps students from groups underrepresented in health care advance their education. A recent alumna of Project L/EARN, Baker is now applying to an accelerated-degree program to earn her master’s degree in nursing so she can become a nurse practitioner in a community-based setting.

“As the population ages, I know there’s going to be a higher demand in the health care field” for nurses with my skill set, Baker says. “With my background in research, gerontology, and public health, I think I’ll be able to bring a little bit more to the table when it comes to health care.”

She is right. And she’s one of thousands of nurses who are pursuing higher degrees in their field so that they, too, can bring more to the patients who will need them.

They’re doing so for myriad reasons: personal and professional fulfillment, greater independence, intellectual challenge, expanded professional options, increased job security, and, in many cases, higher salaries. They are spending four to seven, or even more, years in school and are entering the profession with the kind of knowledge they will need to treat an increasing, and increasingly complex, patient population; conduct groundbreaking research in health and health care; teach the next generation of nursing students; and take positions of leadership as the nation’s ailing health care system is redesigned.

They are nurses like Alam Sharifi, MSN-CNL, RN, a nurse who tacked on an extra three years of studies so she could earn her doctorate and expand her knowledge base; and Emily Haozous, PhD, RN, a former musician who switched courses and earned a research-focused doctorate in nursing so she could help narrow health disparities among American Indians.

Enrollment Surging

Over the last century, nursing education has shifted from hospital-based diploma programs to colleges and universities, which offer associate’s, bachelor’s, master’s, and doctorate degrees in research and practice. Today, enrollment in higher degree nursing programs is on the rise, according to a 2012 survey by the American Association of Colleges of Nursing (AACN). Programs offering bachelor’s degrees in the science of nursing (BSN) grew 3 percent from 2011 to 2012; programs offering master’s degrees climbed 8 percent; and programs offering RN-BSN completion degrees jumped 24 percent, according to the survey, which was based on data from 742 of the nation’s 854 nursing schools with baccalaureate or graduate nursing programs.

Doctorate programs are also growing. Enrollment in research-based doctoral programs inched up 4 percent and enrollment in practice-based doctoral programs ballooned by 27 percent.

“Momentum is clearly building for advancing nursing education at all levels,” AACN President Jane Kirschling, PhD, RN, FAAN, said in a statement. AACN CEO Geraldine Bednash, PhD, RN, FAAN, added in an interview: “It’s really about individuals having improved skills and knowledge for today’s wonderfully complex health care system.”

That’s good news, according a report released by the Institute of Medicine (IOM) in 2010 that found that nurses will need higher levels of education for a number of reasons. While recognizing the enormous contributions of nurses with associate’s degrees, the IOM found that nurses will need more refined skills to care for a patient population that is living longer and to help patients manage more chronic conditions like diabetes, hypertension, arthritis, cardiovascular disease, and mental health conditions. And nurses are likely to have greater primary care responsibilities in the near future, thanks to provider shortages that are becoming more acute as the population ages and as millions of new patients enter the health care system under the health reform law.

Baker, for one, will be ready: She has knowledge of geriatrics, health policy, and health research, which are all skills that will be in high demand among nurses, according to the IOM report. And she expects her master’s in nursing to boost her knowledge in other critical areas such as evidence-based practice, teamwork and collaboration, health care system improvements, and new technological tools and information management systems.

Sharifi will also be prepared. A nurse in Tennessee and an RWJF New Careers in Nursing (NCIN) scholar, Sharifi decided to get a doctorate in nursing practice (DNP), with concentrations in family and mental health care. Her aim is to better understand the effects of mental health medications and to have the necessary academic preparation to meet changing demands in a reformed health care system. “Education requirements are increasing, so getting a DNP just makes sense,” she said. “I don’t want to have to go back to school in the middle of my career; I might as well get it while I’m already in school-mode.”

Haozous, an assistant professor at the University of New Mexico College of Nursing and an RWJF Nurse Faculty Scholar (2011-2014), will be ready for a changed health care system too. She spent nine years earning her master’s and doctorate degrees so she would have the skills she needs to conduct health research on fellow American Indians. She is now one of a small handful of American Indians with PhDs in nursing, and is conducting research into cancer disparities affecting American Indians, a vastly understudied population.

As a professor, Haozous also serves as a role model to nursing students eager to advance their education, and particularly to those of American Indian ancestry. “I want to be here because I can…help build the pipeline and move them forward from their bachelor’s degrees to master’s and PhDs,” she said. “As Native Americans, unless we have that kind of preparation, that education, we have no voice, and we have no place at the table when decisions are made.”

Baker, Sharifi and Haozous are the kinds of highly educated nurses envisioned in the IOM report, which recommends boosting the number of nurses with bachelor’s degrees to 80 percent by 2020 and doubling the number of nurses with doctorate degrees over the same period.

To reach those goals, it recommends promoting traditional RN-to-BSN programs and four-year BSN programs; making it easier for nurses prepared with associate’s degrees to transition seamlessly into baccalaureate programs; finding new providers of nursing education such as proprietary or for-profit schools; supporting simulation and distance learning through online courses; and cultivating academic-service partnerships.

A national campaign backed by RWJF is working to implement those and other recommendations. Launched in 2010, the Future of Nursing: Campaign for Action has established teams of nurse and other health advocates in all 50 states and in the District of Columbia that are working to implement the IOM recommendations. The campaign is also encouraging stipends and scholarships for nurses who want to continue their education.

Hospitals and health care facilities appear to be getting the message about the importance of a more highly educated nursing workforce. Most employers held a strong preference for nurses with baccalaureate degrees, according to a 2012 AACN survey, and nearly 40 percent required baccalaureate degrees. Nurses with entry-level baccalaureate and master’s degrees were also very likely to be hired within four to six months after graduation, according to the survey.

“There is enormous demand for people who are prepared with the skills to function in very complex environments,” Bednash said. “That tells you how attractive nurses with advanced education are and how important it is for nurses to get those graduate degrees.”

Despite increased interest among nurses who are eager to advance their education, nursing schools are still turning away thousands of qualified applicants due to lack of capacity, insufficient access to clinical training sites, and other factors.

“I feel confident we’re going to have a lot of nurses who want to advance their education,” Bednash said. But she added that policy-makers are going to need to do more than provide resources for faculty and student funding to create a more highly educated nursing workforce. “It’s not enough. We need more support for higher education.”

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Imani Baker

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