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In the City, Some Registered Nurses May Not Make the Cut

Sarah Kearns, for HealthLeaders Media, May 19, 2010

As many healthcare organizations battle the nursing shortage that is only expected to worsen as baby boomers retire and the need for healthcare grows, new nurses entering the field in cities may be surprised with how they are greeted: An associate's degree in nursing is not good enough.

A veteran nurse, Joanie McMahon MS, RN, clinical education/organizational development at Mercy Medical Center in Cedar Rapids, IA, says this theory of hiring only those with a bachelor's degree has been around since she entered the nursing world in the early 1980s when there was a hiring freeze at many hospitals.

However, for many new nurses, this may come as a bit of a shock. One Philadelphia nurse was surprised when applying for jobs this spring after he was turned away because organizations were only looking for nurses with a nursing degree or bachelor of science in nursing. Even though this nurse was an RN, the organization was not satisfied with his degree because it was from a community college.

Those looking to become a nurse have three different options. They can go to school for four years and get a nursing degree or bachelor of science in nursing. Option two: They can get an associate's degree and only go to school for two to three years, while option three has the individual going to a diploma school for about three years. All three require would-be RNs to pass a licensing exam that tests basic skills; starting pay is about the same.

In Pennsylvania, there are many diploma schools, despite the fact that many hospitals only accept nurses with bachelor's degrees. For instance, the Hospital of the University of Pennsylvania has enforced this policy since 2004, while many other Pennsylvania hospital systems—Thomas Jefferson University Hospital, Children's Hospital of Philadelphia, and Albert Einstein Medical Center—are following suit and prefer students with bachelor's degrees.

Pennsylvania is not alone; New York and New Jersey have introduced legislation requiring nurses to get bachelor's degrees within 10 years of licensing.

Many of the organizations believe that requiring nurses to have a bachelor's degree or higher is beneficial in the end. Nurses are working with increasingly complex machines and patients, hospitals are moving toward evidence-based medicine, and this sort of thinking may not be emphasized in the more technically oriented associate's degree programs.

"I know of a BSN program that has taken away its hospital-based clinical rotations and are doing the rotations in a simulation lab," says McMahon. "In my book, this is not cutting it. There must be the appropriate balance of the clinical and the classroom didactic time in order to produce a strong critical-thinking nurse that can adapt and flex in today's healthcare world."

For many nurses, working toward getting an associate's degree is an inexpensive and faster way to getting into the profession. Although some facilities will only take those with bachelor's degrees or higher, many healthcare organizations still consider all nurses for job positions.

For instance, if a new RN is applying to organizations located in the city, he or she can try applying to more rural hospitals or positions outside of hospitals. One facility, Hahnemann University Hospitals in PA, looks for the right attitude and thinking skills in a potential new hire, and not particular degrees.

McMahon agrees, stating "it is a combination of the instructor, clinical, curriculum, class time, hands-on, and life experience all rolled into one that make for the perfect new nurse."


Sarah Kearns is an editor for HCPro in the Quality and Patient Safety Group. Contact Sarah at skearns@hcpro.com.

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