The Future of Nursing: Leading Change, Advancing Health (http://thefutureofnursing.org/IOM-Report) includes recommendations related to the educational preparation of nurses at all levels: (a) increase the proportion of nurses with a baccalaureate degree to 80% by 2020; (b) double the number of nurses with a doctorate by 2020; and (c) ensure that nurses engage in lifelong learning. As the complexity of healthcare delivery and patient acuity increases, nurses are expected to demonstrate greater knowledge and expanded competencies in providing care. Are these goals for advancing the overall educational preparation of nurses reasonable? A look at data from the 2008 National Sample Survey of Registered Nurses (NSSRN) (http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf) can lend some insight into the task ahead for all stakeholders.
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There were slightly more than 3 million licensed RNs in the United States as of March 2008. All, however, were not employed in nursing. Half had bachelor's or higher degrees in nursing or a nurse-related field and the highest educational level for the other half was a diploma or associate degree. The most commonly reported educational preparation for initial licensure was the associate program (2 years) with 45.4%, followed by the bachelor's (34.2%), and least the diploma (20.4%). Of the 34.2% new RNs with higher degrees, as initial entry only 0.4% had earned master's degrees and 0.03% doctoral degrees. A growing number of new RNs had a prior postsecondary degree, increased from 13.3% in 2000 to 21.7% in 2008. The average age of completion with an initial bachelor's degree or higher was 28 years, 33 years with an associate, and 31 years for all graduates. For nurses who did return for advanced degrees, the average number of years reported between the associate and bachelor's was 7.5 years, between the bachelor's and master's was 8.2 years, and between the bachelor's and doctorate was 12.4 years (NSSRN).
Several observations can be made from these figures. Students were attracted to nursing programs with shorter preparation and entry into practice. Few newly licensed RNs were representative of young traditional high school graduates entering and completing college in 4 years. Current data about enrollments and graduations is available from the American Association of Colleges of Nursing at http://www.aacn.nche.edu/IDS/datarep.htm. What do these past trends mean today for meeting goals set forth in the Future of Nursing?
Several factors that might influence the capacity of the nursing community to meet the recommendations in the report include personal motivation to achieve an advanced degree, curricula in schools of nursing, faculty and other resources, and the financial burden of tuition costs. What is the motivation to pursue a higher degree initially when one can become an RN in 2 years or less? What are possible barriers to entering or returning to school? Respondents (NSSRN) indicated that 42.7% had funded their education through family resources (parents or relatives); 30.5% via self-pay; 15.9% by federal traineeship, scholarship, or grant; and 10.2% from employer tuition or reimbursement.
Let's go back to the Future (of Nursing). What are possible strategies? Require the bachelor's degree for entry into professional nursing practice? Create curricula to make progression from one degree to a higher one seamless-consider work experience and practice requirements for entry? Although the report provides guidance, the workable solutions must be developed by nurses, other health professionals, and all stakeholders working together toward the stated goals.
Visit http://www.thefutureofnursing.org/ to see how you can become involved and your voice be heard.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
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