Should community colleges offer bachelor’s degrees in nursing?

In most states, community colleges offer only associate degrees in nursing, which require two to three years of education. But in five states—Florida, Indiana, Nevada, New Mexico, and Washington—they offer a four-year nursing bachelor’s degree.

North Carolina could be next. The idea has been brewing for some time, and now the State Board of Community Colleges has formed an ad hoc committee on the “future of community college nursing education.” It is meeting once a month from October through March to discuss the issue.

The impetus for the ad hoc committee was a 2010 report arguing that the 20th-century model for nurse education is insufficient for today’s patient needs. But implementing the report’s vision  could mean a major transformation of both community college systems and the nursing field.

For community colleges, the bachelor of science in nursing (BSN) question is something of a stalking horse for the broader issue of whether they should be allowed to give bachelor’s degrees in a variety of fields.

For nursing, the issue reflects changing demands in the field of nursing and also a variety of special interests.

Traditionally, the job of a registered nurse (RN) has not required a college degree. The Bureau of Labor Statistics (BLS) even identified it as the highest paying job that does not require one. The BLS has projected that between 2012 and 2022, the RN field will grow by 19 percent, a much faster rate than the average among all occupations, 11 percent.

However, jobs are hardly guaranteed in a weak economy—36 percent of licensed RNs who graduated in 2011 did not have an RN job four months after graduation. But 2012 numbers show that around 90 percent of BSN graduates had jobs within four to six months of graduation.

A rising number of RNs, now over 50 percent, are earning bachelor’s and master’s (MSN) degrees, a sign that they believe degrees will enhance their career prospects. The BLS says that bachelor’s degrees are often required for administrative, research, consulting, and teaching positions. According to the Raleigh News & Observer, 44 percent of North Carolina nurses had at least a four-year nursing degree in 2013.

Some employers now require their nurses to have a BSN. Legislators in New Jersey, New York, and Rhode Island have prioposed making it a statewide requirement.  The American Nurses Association favors such mandates, citing research linking advanced degrees and lower patient mortality.

In addition to the push for BSNs, there is also a push to replace MSNs with DNPs—doctors of nursing practice. Six University of North Carolina campuses, along with Duke and Gardner-Webb, now have a DNP degree.

The 2010 “Future of Nursing” report by the National Academy of Sciences’ Institute of Medicine recommended that 80 percent of U.S. nurses have bachelor’s degrees by 2020 and that the number of nurses with a doctor of nursing practice be doubled.

By most accounts, there is a coming shortage of nurses and nurse faculty.According to the American Association of Colleges of Nursing (AACN), in the 2013-14 school year BSN and graduate programs nationwide turned away 78, 089 qualified applicants because of a shortage of nursing instructors.

The impending shortage of nurses is supposed to be caused by the retiring baby boomer generation, combined with the increased demand for healthcare thanks to the Affordable Care Act.

Of course, BLS projections sometimes change, and predicted shortages do not always materialize. United States economists have often warned about STEM shortages, for example, but as the Pope Center has written, those warnings are often overblown. Markets are also intrinsically unpredictable.

In Japan, where people are also worried there are not enough resources to care for an aging populace, companies are starting to manufacture robots to fill the gap. This is not to say that we should invest in robots, but that unexpected developments can change projections.

From the community colleges’ perspective, however, the key issue is that the BSN increases their opportunity to award degrees.

The impacts on colleges could be great, suggested Marcy Stoll, a vice president at the Southern Association of Colleges and Schools Commission on Colleges, who spoke at the October 3 ad hoc nursing committee meeting for North Carolina. (SACS is the major accreditor of colleges in the South.) Community colleges adopting BSN degrees would have to change their mission statements and drop the word “community” from their names, she said.

Such mission creep has been a cause for concern with Florida legislators worried about program duplication and the blurring of the line between community and state colleges, which traditionally serve different functions.

There are some alternatives to the BSN at community colleges. North Carolina and other states are trying to increase the number of skilled—or at least credentialed—nurses through revised articulation agreements between community colleges and four-year schools.

The Foundation for Nursing Excellence, created in 2002 by the board that licenses nurses, has set up a project to allow students to dually enroll at a UNC campus and a community college. The project began in 2008; the first class of students began at Asheville-Buncombe Technical Community College with the goal of graduating from Western Carolina University this year.

If the North Carolina Community College System adopts BSN degrees, it would seem to make that project obsolete. Students could spend the whole four years at their local, cheap, and convenient community college.

Another popular option allows registered nurses who have associate’s degrees or a hospital diploma to return to school to upgrade their résumé.

One of the biggest drawbacks to the community college BSN is the possibility that it won’t be valued as highly as one obtained at a four-year college, a point raised by Roxanne Fulcher, director of health professions policy at the American Association of Community Colleges,at North Carolina’s ad hoc nursing committee meeting. She predicted a debate over whether “a BSN is a BSN,” or if the community college version less valuable.

She thinks the only thing that will make all nurses get a BSN is a government mandate of the kind lawmakers introduced in New York, New Jersey, and Rhode Island.

In any case, it looks as though community colleges in North Carolina will begin to offer bachelor’s degrees. After months of daylong  meetings  to consider BSNs—with multiple advisors, administrators, and college presidents on hand, how likely is it that the board will say no?