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Need for advanced nursing education rising

Monday March 11, 2013
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A nationwide push for nurses with advanced degrees is taking place. In its 2010 report, "The Future of Nursing: Leading Change, Advancing Health," the Institute of Medicine called for doubling the number of doctorate-level nurses by 2020, and the Affordable Care Actís sweeping changes demand a heavy influx of nurses in leadership roles.

Yet nurses considering advanced degrees often find themselves in a Catch-22. They may see the value of higher education, but issues such as family responsibilities and budget constraints make obtaining it a challenge.

As a co-author of the report "Charting the Course for Nursesí Achievement of Higher Education Levels," which appeared in the November edition of the Journal of Professional Nursing, Christine Kovner, RN, PhD, FAAN, explored nursesí barriers to education.

According to the report, the two most common responses nurses gave when asked what keeps them from pursuing advanced degrees were cost and family/children. Also mentioned were lack of time, lack of interest in getting a degree and being too old.

"One of the interesting findings is that less than 1% identified 'no or few local programsí as a reason for not pursuing higher education," said Kovner, a principal investigator for the RN Work Project www.rnworkproject.org, an ongoing national study. She credits this low number to growth in the number of online nursing programs and courses offered by universities on-site at healthcare facilities.

WSUís hybrid program

Providing easier access was the motivation behind the Washington State University College of Nursingís hybrid course design when the school created its DNP program last year.

Coursework is offered at the universityís Spokane and Vancouver campuses. Students who live within a 50-mile radius of either campus come to classes every week. Those outside the radius can get permission to attend some courses from home using live video-conferencing and a real-time chat room.

"Weíve made very intentional decisions over the years not to become an online program," said Cindy Fitzgerald, RN, PhD, FNP-BC, director of the schoolís DNP program. "I think thereís a certain group of students who would rather have a classroom environment, who would rather be able to form study groups with people they communicate with on a regular basis."

To save students travel time, the nursing school groups classes needed for a particular degree track on one given day of the week. The day is set far in advance so arrangements can be made months ahead with employers and families.

Advanced-degree percentages climbing

The number of nurses getting masterís and doctorate degrees has ballooned in recent years, said Jane Kirschling, RN, DNS, FAAN, president of the American Association of Colleges of Nursing.

The AACN tracks trends in degree programs and has seen significant enrollment growth from 2006 through 2011. In that time, enrollment climbed by 67% for masterís programs and 25% for research-focused doctorates. Enrollment for practice-focused doctorates surged upward by 955%.

Many nursing schools are consolidating graduate classes into a limited number of days or going partially or completely online, which helps explain the increased enrollment, Kirschling said. DNP programs have been created with streamlining in mind to avoid what she calls "credit creep," meaning an excessive number of hours, sometimes from duplicative course work, needed to achieve higher degrees.

There also has been a focus on seamless progression, which allows nurses to enter practice at whichever level they like, whether with an associate degree or baccalaureate degree, and know they can pursue a higher degree without having to retake classes or relocate, Kirschling said.

One example of this focus on seamless progression is the RN-to-MSN partnership that began last year between Southeast Hospital College of Nursing & Health Sciences in Cape Girardeau, Mo., and the larger Cox College in Springfield, Mo., nearly 200 miles away. Students with associate degrees from Southeast can take classes online through Cox to get a masterís degree and have to travel to the Springfield campus only once or twice a year, said B.J. Whiffen, RN, DNP, ACNP-BC, FNP-BC, assistant professor at Southeast and coordinator of the clinical program for masterís candidates. Students complete several hundred clinical hours locally with supervision from Southeast professors.

This approach allows nurses to work full time while they study, which is crucial since many are supporting their families, Whiffen said. They also will be more likely to stay in the area when they get their advanced degrees.

"Theyíre not going to move to Springfield to work, theyíre going to stay right here with their families," Whiffen said. "And we need them here. Weíre in a rural, poor area where we need a lot of providers."

Cost containment

Federal and state programs address the problem of cost with scholarships and loan repayment programs. Many nursing schools partner with foundations to create scholarships to ease the financial burden.

A program called the New Jersey Nursing Initiative, a joint venture by the Robert Wood Johnson Foundation, the New Jersey Chamber of Commerce Foundation and nine schools of nursing, aims to help nurses achieve advanced degrees and to create a pipeline of future nursing faculty.

Nurses accepted into the multiyear program — 40 at the masterís level and 21 at the PhD level — received full scholarships to cover tuition and fees, a $50,000-a-year stipend and a laptop. In addition, they receive financial incentives for teaching nursing at least part time in the state after graduation. Covering full tuition allows experienced nurses to go to school full time and graduate more quickly to address a critical need for nursing faculty, said Susan Bakewell-Sachs, RN, PhD, PNP-BC, the initiativeís program director. Nursing faculty vacancies in New Jersey are at 10.5% she said, and those numbers are expected to rise. She hopes the second cohort of 11 doctoral scholars graduating this year will help decrease that vacancy rate.

A group effort

Nursing schools should have conversations with healthcare facilities and regional, state and national foundations to talk about the kinds of positions and educational requirements that are needed and what funds are available to help nurses get that education, Bakewell-Sachs said. Itís also important to work with facilities to establish dual teaching/clinical roles for nurses and look for ways to share resources.

Having those conversations, breaking down barriers and pursuing creative solutions to support more nurses toward higher degrees are crucial as the nursing profession heads into a vulnerable time, Kirschling said. "With the growth of the healthcare industry, the graying of the population, the demands from the Affordable Care Act — weíre going to need every provider we can get," Kirschling said. "Anybody in graduate school today, with whatís on the horizon, will not have problems doing the work that they want to do." •


Marcia Frellick is a freelance writer.Write to editor@nurse.com or post a comment below.