The 1990 Seventh Report to Congress on Health Personnel
estimated by the year 2000 there would be half as many baccalaureate- and higher-degree nurses as would be needed.17
This conclusion has been reiterated by subsequent federal workforce groups, including the National Advisory Council on Nurse Education and Practice (NACNEP), policy advisers to Congress and the U.S. Secretary of Health and Human Services on nursing issues, which urged in 1996 that policy actions be taken to ensure that at least 66 percent of nurses would hold a baccalaureate in nursing (BSN) by 2010.18
The actual result will fall short of that goal—closer to about 45 percent—including nurses who have already obtained one additional degree to transition from associate degree (AD) to BSN.
Educational composition of the workforce
We were interested in whether the educational composition of the nurse workforce could be a contributing factor to the shortage of faculty and the flattening of enrollments in APN programs. If the different pathways into nursing produce graduates with very different long-term educational attainment, greater growth in one pathway could negatively affect numbers of nurses with graduate preparation in future nurse cohorts, thus potentially exacerbating the shortage of faculty and advanced-practice clinicians.
To explore this further, we analyzed nonpublic data from the 2004 National Sample Survey of Registered Nurses, a weighted national probability sample of 37,635 licensed RNs. We examined the highest educational qualifications of nurses who received their initial prelicensure education in an AD or BSN nursing program—the two educational pathways that now account for more than 95 percent of new nurse graduates.19
Of the nearly 1.4 million nurses who obtained an AD or BSN during 1970–1994, 59 percent obtained an AD as their initial degree, and 41 percent obtained a BSN (). Although only 6 percent of nurses who initially obtained an AD had gone on to earn an master of science in nursing (MSN) degree or doctorate by 2004, nearly 20 percent of the initially BSN-prepared nurses had done so. Thus, just under 159,000 nurses obtained graduate education in a quarter of a century and thus were eligible to teach in nursing schools or become NPs.
EXHIBIT 2 Observed Numbers Of Nurses With Associate Degrees (ADs) And Bachelor Of Science In Nursing (BSN) Degrees With Initial Education Between 1970 And 1994 Who Went On To Obtain Master Of Science In Nursing (MSN) Or Doctoral Degrees, And Expected Numbers Under (more ...)
What might have been expected had the percentages of nurses initially trained as AD and BSN nurses been the opposite of what it is now, or 33 percent AD versus 66 percent BSN, which was recommended in 1996 by the federal advisory committee on nursing (NACNEP)? Under that scenario, nearly 209,000 nurses would have been expected to obtain graduate education, or roughly 50,000 more than actually did so ().
Although AD-prepared nurses were as likely as BSN-prepared nurses to seek another degree, 80 percent of the time they went on only to obtain a BSN. For each 1,000 AD nurses trained, the number who went on to obtain an advanced degree (58) was less than one-third of the number of BSN nurses (197) who did so (data not shown). Using unpublished data from the National Sample Survey of Registered Nurses 2004, we calculated that three times as many AD nurses as BSN nurses would have to be educated to produce as many nurses with graduate degrees who could qualify for faculty positions.
These analyses suggest that having enough faculty (and other master’s-prepared nurses) to enable nursing schools to expand enrollment is a mathematical improbability, given current patterns of prelicensure nursing education. This finding is similar to that of a cohort analysis of North Carolina nurses using a different database.20
The analyses show that nurses educated initially in baccalaureate programs are significantly more likely than AD nurses to obtain graduate education qualifying them for faculty and advanced-practice roles.
The trend of AD nurses’ constituting a larger share of all new graduates—about two-thirds at present—results in a feeder stream of nurses to graduate study that is simply too small to meet the multiple needs for more-educated nurses in an evolving health care system. The one-third of new nurses who receive their initial education in baccalaureate programs produce the greatest pool of nurses for faculty positions, advanced clinical practice, and administration.
Implications for future policy
We cannot, of course, change the past, but these numbers have important implications for the future. Among the many useful recommendations considered for solving the faculty shortage in the future, changing the distribution of initial education toward more BSN graduates through targeted public subsidies warrants greater attention. Steering the composition of the future nurse workforce is an objective that lends itself to public policy intervention. Many of the other options for solving the faculty shortage, including curriculum innovations and improved working conditions for faculty, are less amenable to public policies and more the domain of educators assisted by private foundations.