A threat to the backbone of our healthcare system

Efforts to restrict access to the nursing profession would harm us all
By Thomas J. Snyder, President
Ivy Tech Community College of Indiana

A few months ago, I was visiting a friend in the hospital. As I observed the staff attending to him, I was immediately impressed by the quality of care he received. It was clear that he was their priority, and that he was in very good hands.

As I considered this, another thought struck me: while a wide variety of professionals were involved in my friend’s care, the one true constant was the nursing staff. They were his lifeline. They were most responsible for his satisfaction at their facility—and more importantly, most responsible for his likelihood of making a complete recovery after he was sent home.

My personal experience reflects a national reality: nurses are the backbone of our nation’s healthcare system. And as our population ages, the continued growth of our nursing workforce will be more critical than ever before.

Despite this fact, a burgeoning movement is underway that would limit access to careers in the field. A small contingent of special interest groups is advocating that certain hospitals—those seeking to attain “nursing magnet” status—restrict employment only to those with bachelor’s degrees in nursing (BSN). Their efforts would have catastrophic results not just for those with associate degrees in nursing (ASN), but for our nation’s healthcare system as a whole.  And may result in increased health care costs.

One of my greatest concerns is that their position is supported by claims that just aren’t true. For example, those promoting the BSN as a necessary prerequisite to a nursing career infer that ASN-credentialed nurses provided a diminished quality of care as compared to BSN-credentialed nurses. However, there is no evidence supporting these claims. Even studies that call for an increase in BSN-credentialed nurses—including a 2010 study by the Institute of Medicine of the National Academies—have found no relationship between the education level and patient outcomes.

There’s one primary reason that may explain why a different credential is not correlated with a different patient outcome: all candidates, regardless of their education level, take the same national licensure exam to become RNs—the National Certification Licensing Examination (NCLEX).  Today, in fact, the majority of new RNs are educated in ASN programs. If the NCLEX is the true determinant of career readiness, then, how can it be argued that one path that prepares students for the NCLEX is superior to another?

The truth is, this argument is invalid, and it obscures the very real need for nursing candidates to have options. For many, a BSN is the best choice because it gives them an advantage in competing for management positions. For others, even a BSN is not enough: if they want a career in nursing education, they will likely need to attain a master’s of science in nursing (MSN). For others, however, an ASN is not only the best choice—it may be the only choice, given the unparalleled affordability offered by community colleges.

This is certainly the case for nursing candidates who chose Ivy Tech Community College. Our full-time students pay just $3,334 per year for tuition, a fraction of the cost of the average Indiana college. It’s notable, too, that this does not factor in fees, room, and board charged by other colleges, which in itself adds up to thousands of dollars. This helps students and their families stay out of debt and makes it more likely they will remain in college since they are less likely to be held back due to competing financial responsibilities. Because the ASN is without question the most affordable pathway to a nursing career, therefore, retaining that option will make the profession accessible to the largest number of aspiring nurses.  Why should we cause more debt for some that are already in a difficult financial position, who are looking to find a career that can change that?

The ASN credential plays another critical role in preparing professionals in that credits earned in the program can be transferred to four-year institutions. So for some that means if they wish to pursue a BSN they can get started at a community college, continue on toward a BSN, and save thousands of dollars in the process.

The bottom line is that nurses are the backbone of our healthcare system, and we will need more of them—a projected 1 million additional RNs by 2018—as our population ages. Our best chance of ensuring that we are prepared to respond to this need is by making the profession accessible to all qualified candidates, including those credentialed with an ASN or a BSN. So, when you hear the arguments in favor of limiting the nursing profession to those with a BSN, ask yourself whether such restrictions would be in the best interest of everyone who depends upon our healthcare system, or just those who would benefit from shutting out otherwise qualified candidates.

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