In Historic Shift, More Nurses Graduate with Bachelor’s Degrees

The nation’s nursing workforce has reached a critical tipping point. In 2011, for the first time ever, the number of nurses who earned baccalaureate degrees in the science of nursing (BSN) was higher than the number who earned two-year associate degrees in nursing (ADN), according to a recent study of newly available government data about nurse education.

The change marks an historic shift in nurse education levels; in every year before 2011, the number of nurses earning ADNs outpaced those earning BSNs.

By 2012, more nurses (53 percent) were earning four-year baccalaureate than two-year associate degrees (47 percent). The percentages were mirror images of each other a decade earlier; in 2002, 55 percent of nurses earned an ADN and 45 percent earned a BSN.

Overall, we found that growth in nursing education over the past 10 years has been substantial and broad-based, occurring among both associate and baccalaureate programs, and has included people from all racial and ethnic backgrounds,” said the study’s lead author, Peter Buerhaus, PhD, RN, FAAN, a professor of nursing at Vanderbilt University.

A strong driver of the change is an explosion of accelerated Registered Nurse (RN)-to-BSN nurse education programs, which enable RNs and nursing students to earn bachelor’s degrees in shorter time periods than do traditional four-year BSN programs.

The study found that more than half of new entrants in traditional nursing programs are still in ADN programs, noted Joanne Spetz, PhD, FAAN, associate director for research strategy at the Center for the Health Professions at the University of California, San Francisco. But many nurses—more than in the past—start out earning ADNs and sometime later move into BSN programs. That accounts for much of the surge in BSN-prepared nurses, Spetz explained.

The study was published in the June issue of Nursing Economics and was written by Buerhaus, David I. Auerbach, PhD, and Douglas O. Staiger, PhD. Researchers obtained data from the Integrated Postsecondary Education Data System (IPEDS), a system of surveys conducted annually by the U.S. Department of Education. It does not distinguish between BSNs earned as initial degrees from BSNs earned as second degrees.

Higher Share of BSNs in California

Meanwhile, the share of nurses with BSNs is growing rapidly in California, the nation’s most populous state. In 2014, 61.5 percent of the state’s nurses had completed a BSN or higher, up from 53 percent in 2012, according to a survey by the California Board of Registered Nursing.

That news drew praise from Susan B. Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation (RWJF) and director of the Future of Nursing: Campaign for Action, a joint effort of RWJF and AARP that is working to transform health care through nursing and build healthier communities for everyone in America. The news “shows the state is on a great upward trend,” Hassmiller said.

One of the Campaign’s key goals is to create a more highly educated nursing workforce to ensure that nurses will have the skills they will need to care for an increasing, and increasingly complex population of patients that is living longer and managing more chronic conditions. Mounting evidence links nurses with BSN degrees or higher to improved patient outcomes.

The Campaign has been working for five years to encourage and enable more nurses to advance their education. The effort is grounded in a 2010 report by the Institute of Medicine (IOM) that called for sharp increases in the numbers of nurses with BSNs and doctorates by 2020.

More nurses are earning graduate degrees, the Nursing Economics study found—another sign that the Campaign is making progress toward implementing the IOM report’s recommendations. The number of RN graduates of master’s and doctoral programs has risen dramatically in recent years—jumping from just under 10,000 in 2003 to more than 30,000 in 2012.

The shift in educational patterns suggests that the “nursing education system has moved in step with the IOM recommendation for an RN workforce comprised mostly of nurses prepared in baccalaureate nursing education programs by 2020,” Buerhaus and his colleagues write.

The nursing workforce is also becoming larger and more diverse, the study finds. The total number of graduates from BSN and ADN programs more than doubled, jumping from 77,000 to 184,000, between 2002 and 2012.

And although the vast majority of BSN and ADN graduates continue to be white and female, nursing students are becoming more diverse. Between 2002 and 2012, the share of male nurse graduates rose, from 10 to 13 percent, and the percentage of graduates who identified as white dropped from 73 to 66 percent.

That growth is “encouraging,” Buerhaus and his colleagues write, because it means nurses will be able to better meet higher demands for their services from a growing and aging population, an increasing number of people with chronic diseases and an influx of people with new health insurance.

Whether the growth will offset future nurse shortages is unclear, though, because there aren’t yet estimates about how health care delivery and payment reforms will affect demand for RNs.

“Therefore, despite the recent and substantial growth in the number of RN graduates, it is difficult to determine if enough RNs are being produced to replace retiring RNs, let alone add enough RNs to the workforce to adequately meet the future demand for nurses,” the research team concludes.