In the last week, since we released some enlightening numbers on the output of registered nurses versus estimated demand, we’ve gotten lots of great feedback. Paul Tosto at Minnesota Public Radio has continued the discussion with two more posts (see here and here), and others have chimed in as well.
One of the commenters on EMSI’s blog and MPR’s site was Mary Bennett (pictured), the Director of Western Kentucky University’s School of Nursing in Bowling Green. She raised a variety of important issues after seeing EMSI’s data, like the fact that many nurses will get an associate’s degree, start working, and then go back for a bachelor’s degree or advanced training. This trend makes data analysis very tricky.
To flesh out some of these factors and get more of Bennett’s perspective, we talked with her over the phone. Bennett said graduates from WKU’s baccalaureate program aren’t having trouble finding jobs, but the issue might be at the two-year level. “I think [the US is] probably at this point overproducing associate-degree nurses,” she said.
Below is the transcript of our full conversation.
EMSI: Because of all the complicating factors, is nursing one of those occupations that it’s hard to get a true read from labor market data and educational output data?
Mary Bennett: That is true. What the problem is, if you just look at graduate output, that graduate output will include both current RNs, who most likely already have jobs, in addition to new RNs. So you have to be careful that you’re only looking at what we call graduates of pre-licensure programs, meaning they don’t already have an RN license.
EMSI: Does that include community colleges?
Bennett: The community college will usually be a source of pre-licensure graduates. They’ll be graduates at the associate’s-degree level, if you’re only looking at RNs. So those will be pre-licensure. But when you look at the university graduates, that’s when you’re going to get your blended — you’ll see some pre-licensure, but a lot of the university graduates will actually be RNs from a community college who are obtaining a second degree and coming out with a bachelor’s in nursing.
EMSI: And that will have a big effect on the data, right?
Bennett: Right. Because if you just ask for all the graduates in nursing programs, undergraduate nursing programs, you’re going to get both pre-licensure students and a significant amount of what we would call post-RN students, or students pursuing a second degree essentially. That’s part of the problem with the data, unless you’re really careful and only get pre-licensure students from that university graduate mix. And it’s kind of hard to tease out when you just ask a program, how many graduates did you produce? They just give you a ballpark [figure] — this is the number of graduates, but they don’t tell you so many were pre-licensure and so many were RNs pursuing a second degree.
One of the more interesting questions … we may in fact be overproducing a certain type of registered nurse. I think we are probably at this point overproducing associate-degree nurses because of the movement of the whole country toward the baccalaureate and several states have legislation pertaining to the BSN in 10, which means Associate Degree nurses must attain a bachelor’s degree in 10 years or lose their license as a nurse. The continued production of high numbers of associate-degree nurses probably needs to be looked at. And I think that some hospitals have just stopped hiring associate-degree graduates in certain areas and pockets of the country because of market right now being more selective where they can actually choose who they want to hire, the associate-degree graduates are having a tough time right now.
EMSI: I’m guessing with the recession and with the economy, people are wanting to either switch careers or are looking at nursing and saying, “All right. I can get a two-year degree, I can make this much money.” Then once they get done, I guess that’s where the issue comes if hospitals are not hiring associate-degree nurses.
Bennett: Right, and these people are angry and I don’t blame them because they’ve been told, “You can always get a job in nursing. You can get a two-year degree and you can get a job,” and all the sudden they’ve graduated into this job market where the employers are saying we’re not hiring associate-degree graduates any more. That’s really tough.
At Western, we have both the baccalaureate [program] and we have a community college [Bowling Green Community College] owned by the university. We’re still producing associate-degree graduates, and we’re actually looking at this to see how long we want to continue doing this and how many should we produce. Of course we’re going to continue to provide a way for associate-degree graduates to become baccalaureate graduates. There will always be some type of degree completion program for AD graduates. But we’re wondering if maybe we should start cutting down on the production of associate degree nurses.
EMSI: I’m guessing some of your graduates come from Bowling Green Community College?
Bennett: We have what we call a post-RN program, and probably in that program two-thirds of them are associate-degree graduates from our community college. And the rest come from various community colleges in the three-state area.
EMSI: At Western Kentucky, you said as many as half of your graduates had previously earned associate’s level degrees?
Bennett: Right. When we graduate, say we have 80 students coming out in May, at least half of those students were already RNs. They are graduates of our post-RN baccalaureate program. The remaining 40 were actually true, what we call pre-licensure students graduating with their first RN license.
EMSI: Do you get the sense, obviously it’s hard to know, but does that trend play out in most other areas in the country where most college have that mix?
Bennett: I would say a lot of the four-year universities would have that. Just about every major nursing program that offers a four-year degree also offers some sort of a post-RN BS completion. Whatever they call it, it’s some way for a two-year associate degree nurse to attain a baccalaureate degree.
EMSI: Because it’s a nuanced issue, is it best to wait once we get farther along post-recession to see how things are playing out before any kind of systemwide changes are made? What’s your thoughts on that?
Bennett: We’re looking at this national level; I’m a member of the American Association of Colleges of Nursing. This is one of things we talk about every time we get together once year. OK, where are we at in terms of numbers, and do we need to consider either increasing or decreasing the number of students we admit into our programs. We try to keep handle on it, but that’s only for the baccalaureate and higher degree programs. The associate degree programs are under another accrediting body, and I’m assuming they’re doing the same thing when they get together at the national level.
At the state level, we get together with both the associate and baccalaureate programs every year, look at numbers, look at how many of our graduates are getting jobs and decide whether or not we need to increase or decrease the flow of students into and out of these programs. So as a profession we don’t want to have a lot of students graduating and not finding jobs. But at the same time, we have people from the hospital and nursing homes sitting on these committees saying, “Please, please, please, we still need help — don’t stop. So we have to balance that. We look at how many of our new graduates are left without a position. At graduation last year in May, 70% of my new graduates already had jobs before they ever left the door. What other profession has that kind of acceptance rate?
But we almost have a sense of entitlement, our new graduates. If they don’t get the job they want and the shift they want and the town they want, they’re very bitter about it because they’ve always believed and been told, “You can always get a job in nursing.” And there usually is — this year is not just one of them.
EMSI: You mention students getting nursing degrees and opting not to work at hospitals — nurse practitioners, nurse educators, and also how many are becoming traveling nurses or going into the military? That would probably obscure the data too, correct?
Bennett: Well, that’s true, but traveling nurses are still taking jobs of some sort. There’s usually a big call for traveling nurses when there are fewer nurses available to work regularly. Because traveling nurses are expensive; hospitals only use them when they’re desperate.
I would say a small minority actually go into the military as a full-time career, although certainly there are a lot of nurses in the reserves. But they’re still working a regular nursing job.
The area where there really is a shortage right now that we’re really underproducing is at the master’s [level] and higher. The nurse educators, the nurse practitioners, the nurse anesthetists. There’s a huge shortage of those throughout the country, so we’re trying to get more nurses to head that direction, which takes them away from your basic bedside nurse.