Ms. Munkvold is OCNE Evaluation Project Research Associate, and Dr. Tanner is AB Youmans Spaulding Distinguished Professor, Oregon Health & Science University School of Nursing; and Ms. Herinckx is Associate Director, Regional Research Institute, Portland State University, Portland, Oregon.
This project was supported by a grant from the Robert Wood Johnson Foundation.
Dr. Tanner was not involved in the peer review or decision-making process for this manuscript.
The authors have disclosed no potential conflicts of interest, financial or otherwise.
Address correspondence to Christine A. Tanner, PhD, RN, FAAN; e-mail: firstname.lastname@example.org.
The Oregon Consortium for Nursing Education (OCNE) is a coalition of community colleges and the five campuses of Oregon Health & Sciences University (OHSU), created in response to the projected nursing shortage (Tanner, Gubrud-Howe, & Shores, 2008). OCNE faculty co-developed a shared curriculum and academic standards that include common prerequisites, criteria for co-admission status, and spiraled coursework to facilitate a seamless progression from community college to the baccalaureate degree. Upon completion of an associate of applied science (AAS) degree and the NCLEX®, the students of an OCNE partner community college can transition directly to OHSU for the completion of the baccalaureate degree. Since the first class of associate degree (AD) graduates in 2008, 228 students have progressed directly toward the bachelor’s degree at OHSU—a proportion considerably less than what had been projected. The purpose of this study was to explore the factors that influence OCNE associate degree graduates’ decisions to postpone or stop academic progression toward the bachelor’s degree.
This study is particularly significant in light of the key recommendations of the Institute of Medicine’s (IOM) 2010 The Future of Nursing report, particularly the goal for 80% of the RN workforce to have a bachelor’s degree by 2020. The OCNE curriculum was conceptualized as a baccalaureate curriculum with the option for community college students to exit with the AAS degree, to become licensed, to transition seamlessly for a 1-year baccalaureate completion, or a combination of these options. Hence, some previously identified barriers to baccalaureate completion were removed—students could continue their education with the same cohort; they would not have to repeat any coursework (i.e., the fourth year would build directly on the third-year coursework); they could complete the fourth-year coursework in their home community; and their credits and financial aid would transfer to the university for the fourth year.
The number of members of the three cohorts entering OCNE partner community colleges in 2006, 2007, and 2008 who initiated the baccalaureate completion option at OHSU has varied from 23%, 32%, and 28%, respectively. Because students in the baccalaureate completion program may defer matriculation or pursue their studies on a part-time basis, complete graduation data for each cohort are not yet available. A comparative national rate of baccalaureate degree completion during these 3 years is also unavailable. The most current national data of “recent” (2001–2004) AD and diploma graduates provides a significant comparison, with only 9.6% of this cohort obtaining a baccalaureate in nursing or a related field by 2008 (Health Resources and Service Administration [HRSA], 2010, section 9.3, p. 204).
During the past 3 years, an average of 30% of OCNE community college students continued toward their bachelor’s degrees—a remarkable improvement over the recent national average of 9.6%. However, this proportion falls well below the 70% for direct academic progression informally projected by OCNE leaders in 2003. Our study was initiated to explore the factors that have affected OCNE students’ decisions to directly continue toward the baccalaureate degree.
Several recent studies address the factors that influence experienced AD RNs’ decisions to pursue an advanced degree. Common themes include multiple role demands (work and family), limited resources (money and time), questionable relevance and value of the degree, and lack of self-confidence, as well as lack of faith in academic institutions (Delaney & Piscopo, 2004; Lillibridge & Fox, 2005; Megginson, 2008). Even experienced AD RNs harbored concerns about the flexibility of academic programs, as well as harboring concerns regarding required academic rigor and the relevance of academic progression (Delaney & Piscopo, 2007; Morris & Faulk, 2007; Spencer, 2008).
Nationally, the timing of academic nursing progression from associate to bachelor degree averages 7.5 years after initial licensure (HRSA, 2010, p. 62). Several researchers report that personal and professional incentives for academic progression increase 5 to 8 years after initial nursing education (Delaney & Piscopo, 2007; Lillibridge & Fox, 2005). During this time frame, nurses often report becoming disillusioned with the current health care system and begin to recognize professional and personal limitations to nursing practice as a staff nurse (Megginson, 2008; Spencer, 2008).
This study was designed to address the question, “What factors influence community college students’ decisions to continue directly for the baccalaureate degree?” The study was reviewed and classified as “exempt” by the OHSU Institutional Review Board.
We identified 208 OCNE students who completed their AD in 2010 but did not enroll in baccalaureate coursework at OHSU within 6 months after AAS graduation and RN licensure. Through e-mail, we requested their anonymous completion of a 15-item Web-based survey. To increase response rates, we sent two follow-up reminder e-mails with links to the survey. Of the 208 graduates, 87 (42%) responded to the survey. The survey examined variables of employment status, intent and timing to continue academic nursing education, and other factors that influenced their decision regarding academic progression. In addition, in the attempt to learn what “the word on the street” was to these graduates, items were included to determine perception of support for baccalaureate completion from college faculty, nursing peers, nurse managers, and community college peers, along with space for open-ended responses.
Most (84%) of the survey respondents reported being employed in any field at the time of the survey, with three quarters of these holding full-time employment. Most of the respondents (75%) were employed as RNs. These findings reflect the most current national data, indicating the highest rates in nursing employment and full-time nursing employment since 1977 (HRSA, 2010, section 3.2, p. 67). Such results reflect the effects of the current U.S. recession on nursing employment for experienced and new nurses.
Intent To Continue Academic Nursing Education
Six (7%) of the respondents reported current enrollment in academic institutions other than OHSU. Factors reported in the decision to enroll outside the OCNE partner schools were (a) less cost (tuition of nursing and non-nursing credits), (b) less clinical time required, and (c) desire for a different degree (RN-to-MSN degree program).
Nearly 60% of respondents reported intent to continue nursing academic education in the future, which is reduced somewhat from the 70% intent found in previous surveys of this cohort during their AD education. More than half reported their intent to return to academia within 1 to 2 years, with the remaining intending to return between the 3-year to 4-year and the 5-year to 6-year intervals, representing a continuation pace much faster than the 7-year national average.
Fifty percent of the respondents who planned to continue their education indicated OHSU as their only identified choice, another 21% included OHSU with other prospective online institutions, and slightly more than 20% indicated that OHSU was not in their consideration for a nursing baccalaureate, predominantly due to a higher cost of tuition. Nine percent of respondents omitted their choice of institution.
Factors Influencing Academic Progression Decision
Factors influencing the decision to discontinue academic nursing education at this time were, in ranked order, financial concerns, conflict with time and energy for work, and conflict with time and energy for family. These factors are supported in prior research (Delaney & Piscopo, 2007; Zuzelo, 2001) on more traditional AD curriculum graduates. Financial concerns were further defined to be cost of tuition (reported by 41%), need to produce family income (39%), and concern with current debt load (17%).
Additional factors influencing the graduates’ decision included age, prior non-nursing bachelor’s degree, and pursuit of further education outside of academia. Respondents writing on the influence of their age were between 49 and 58 years old. More than 20% of these OCNE AD students hold a prior non-nursing bachelor’s degree and, of these, 15% expressed the desire for RN-to-MSN education. Another 5% of all respondents reported seeking professional certifications in practice areas rather than academic progression at this time.
Perception of Support for Baccalaureate Completion
Regarding the level of support from their academic community, 88% of the respondents indicated that their community college faculty were somewhat supportive to highly supportive of academic progression, 56% reported that their RN peers were supportive, and a slightly higher number (58%) of respondents indicated their nurse managers were supportive.
Slightly more than one third (35%) of respondents expected to receive a salary differential from their current employer for the completion of a nursing baccalaureate. In terms of tuition subsidy, only 28% reported any currently available financial support, with another 23% of employed graduates anticipating tuition assistance after a year of employment. The reported tuition support ranged from $700 to $1,500 per year.
In response to a question soliciting additional comments, the most frequently identified concerns were about academic workload, non-nursing course and clinical requirements of the fourth year, paperwork required to transfer to the university, and feeling disconnected from university faculty. Several students expressed pride in the OCNE curriculum. Nearly half of the respondents described a large amount of peer-to-peer interactions and discussion, often through social networking, regarding the decision about academic progression.
Discussion and Implications
In the first 3 years of the OCNE curriculum, the proportion (30%) of the AAS graduates continuing toward the bachelor’s degree within 3 years of completion of the AAS is three times greater than the national average (9.7%) 5 years within initial nursing education. On annual surveys of students enrolled in OCNE programs, 60% indicated they plan to continue for the bachelor’s degree in the future. These trends are encouraging; however, the proportion falls far short of the IOM The Future of Nursing (2010) report goal of 80% by 2020. Many of the barriers to academic progression reported in previous studies (Delaney & Piscopo, 2007; Megginson, 2008; Zuzelo, 2001) were not evident or not as prominent in this sample (e.g., doubt about the relevance or value of the degree, inflexibility of academic programs, or lack of “academic self-confidence”).
As in past studies (Delaney & Piscopo, 2007; Spencer, 2008; Zuzelo, 2001), financial hardship was most commonly cited as the primary deterring factor for this sample. For our cohort, the economic shifts that began in 2008 have likely been significant. According to Oregon personal income tax collections, a 10% reduction in personal income was experienced by the typical Oregon family in 2008, which decreased further to 30% in 2009, increasing to only a 14% reduction in 2010 (Oregon Office of Economic Analysis, 2010). A companion statistic of Oregon unemployment indicates rates of 11.6% in June 2009 that remained essentially unchanged at 10.5% unemployment through Sept 2010 (Oregon Office of Economic Analysis, 2010). These indicators reveal that during their community college years, the 2008 cohort experienced the most significant downturn in Oregon employment and personal or family income since the recession of the early 1980s. Given that community college nursing students are statistically more likely to be head of households than are their university peers (HRSA, 2010), it is also likely that this cohort would choose employment over increasing their debt load by pursuing additional education.
Most of the respondents were employed full time in nursing, demonstrating the primary factor (financial considerations) for their delay toward academic progression. However, the current decrease in employment opportunities for new graduates of nursing programs may likely have influenced the proportion of those continuing their education; other influences may include their financial status, ability to secure additional financial aid, and willingness to increase their debt load. Of significant concern is the respondents’ report of limited tangible support in terms of salary increase for advancing their nursing education or employer-assistive tuition subsidy amounts. This lack of perceived financial support and encouragement for academic progression in the workplace bears further study, ideally in collaboration with health care partners.
Demographic shifts in the typical community college population have been noted, and OCNE community colleges are no exception. The number of students with prior baccalaureate degrees, who chose community college as a relatively inexpensive route to a career change, has dramatically increased. Development of academic progression programs that recognize these academic accomplishments (e.g., RN-to-MSN) will likely enhance achievement of the IOM academic progression goals. The IOM’s goal is based on studies that explored the relationship between levels of education and patient outcomes. Future studies may reveal the qualities of education, rather than the degree designation per se, that contribute to these positive relationships.
Our study points to other potential interventions to encourage academic progression. OCNE community college faculties emphasize the importance of continued education. A greater effort is needed to explore and clarify messages from the work-place regarding the value of the bachelor’s degree. Increased financial incentives and salary differentiation would provide concrete evidence of this support. Significant peer informal networking occurs around the decision regarding academic progression. University admissions personnel should consider implementing recruitment activities to include current and past students with completed baccalaureate degrees who would interact with prospective students, for example, to create more accurate, positive peer-to-peer networking.
The innovative OCNE, with its seamless transition to a baccalaureate degree, has increased the proportion of community college students seeking to advance within the first 3 years of graduation. In a subsequent article, we will report results from student focus groups regarding decision making surrounding baccalaureate completion. Further, we will continue to evaluate these trends, particularly focusing on longer-term baccalaureate completion rates.
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