Journal of Nursing Education

Major Article 

A National Survey of RN-to-BSN Programs: Are They Reaching Rural Students?

Melinda A. Merrell, PhD, MPH; Janice C. Probst, PhD; Elizabeth Crouch, PhD; Demetrius A. Abshire, PhD, RN; Selina H. McKinney, PhD, APRN, PMHNP-BC; Eboni E. Haynes, PhD

Abstract

Background:

Increased representation of Bachelor of Science in Nursing (BSN)–prepared nurses improves health and reduces costs. Fewer rural U.S. nurses have BSN degrees compared with the national average. RN-to-BSN programs provide an opportunity to increase the number of BSN-prepared rural nurses. However, the number of these programs targeting rural students is unknown.

Method:

Directors of RN-to-BSN programs were surveyed regarding program characteristics and efforts to target rural learners. Using mail and online return options, the response rate was 31.3%.

Results:

Only 38% of programs targeted rural RNs for recruitment. Supports for rural student recruitment and retention, including partnerships with community colleges, rural clinical placements, and online offerings, were limited in number and/or scope.

Conclusion:

RN-to-BSN programs with the capacity to recruit and retain rural learners may help increase the number of BSN-prepared rural nurses. Increased collaboration among stakeholders will support rural nurses in continuing their education. [J Nurs Educ. 2020;59(10):557–565.]

Abstract

Background:

Increased representation of Bachelor of Science in Nursing (BSN)–prepared nurses improves health and reduces costs. Fewer rural U.S. nurses have BSN degrees compared with the national average. RN-to-BSN programs provide an opportunity to increase the number of BSN-prepared rural nurses. However, the number of these programs targeting rural students is unknown.

Method:

Directors of RN-to-BSN programs were surveyed regarding program characteristics and efforts to target rural learners. Using mail and online return options, the response rate was 31.3%.

Results:

Only 38% of programs targeted rural RNs for recruitment. Supports for rural student recruitment and retention, including partnerships with community colleges, rural clinical placements, and online offerings, were limited in number and/or scope.

Conclusion:

RN-to-BSN programs with the capacity to recruit and retain rural learners may help increase the number of BSN-prepared rural nurses. Increased collaboration among stakeholders will support rural nurses in continuing their education. [J Nurs Educ. 2020;59(10):557–565.]

The nursing profession has been charged to increase the proportion of Bachelor of Science in Nursing (BSN)– prepared nurses to 80% by 2020 (Institute of Medicine [IOM], 2010). BSN degree preparation among nurses has been associated with improved outcomes, including reduced patient morbidity, mortality, and associated costs (Aiken et al., 2017; Hawkins et al., 2018; National Advisory Council on Nurse Education and Practice [NACNEP], 2010). Nationally, more than half of nurses have earned a bachelor's degree or higher (U.S. Department of Health and Human Services [DHHS], 2019). However, in rural areas, Census data from 2011–2015 indicated that only 46% of nurses were bachelor's prepared or better (Probst et al., 2019). This proportion has been found to decrease as rurality increases (Skillman et al., 2006; Smith et al., 2019).

Rural areas may especially benefit from a more highly educated nursing workforce that is better equipped to address medically complex patient populations (Baernholdt & Mark, 2009; Bratt et al., 2014). Rural residents tend to be older and have complex health issues associated with higher rates of chronic diseases such as diabetes, cardiovascular disease, cancer, and mental health disorders (Barton & Azam, 2017). Despite patient complexity, nurses working in rural areas have reported higher patient-to-nurse caseloads than nurses working in urban areas (Baernholdt & Mark, 2009). Further, health care services in rural areas are often under-resourced or absent, resulting in challenges in providing care across the spectrum of needed services (Cramer et al., 2009). In this environment, rural nurses also experience more interpersonal demands due to their connections to the communities where they work (Bratt et al., 2014). These demands—as well as greater professional isolation and practice autonomy in rural nursing—require leadership skills that are taught during BSN preparation (Bratt et al., 2014; Spencer, 2008).

Educational efforts to increase the number of nurses obtaining BSN degrees include RN-to-BSN and other bridge programs, which fill educational gaps between diploma or associate-level nursing preparation and baccalaureate education (American Association of Colleges of Nursing [AACN], 2008; IOM, 2010). Given the relatively high proportion of associate degree RNs in rural areas, RN-to-BSN programs are well-positioned for encouraging development of a more highly educated nursing workforce in rural areas (HRSA, 2013). Hospital-led efforts to hire bachelor's-prepared nurses for maintenance of accreditation or Magnet® status increases the demand for a more highly educated workforce (Conner & Thielemann, 2013; NACNEP, 2010). As of late fall 2018, 777 schools in the United States offered RN-to-BSN programs (AACN, 2019a).

To date, there has not been an examination of if or how RN-to-BSN programs specifically target rural nurses for recruitment and retention in their programs. Although some RN-to-BSN programs reportedly focus on rural nursing, the overall number, distribution, and characteristics of these programs is unknown (Hawkins et al., 2018; Southwest Minnesota State University, n.d.). A previous national survey of RN-to-BSN programs did not examine this issue (McEwen et al., 2012). In addition, since the time this previous national survey was conducted, the total number of RN-to-BSN programs has increased 20%. An examination in both overall changes in the characteristics of RN-to-BSN programs over time, as well as their interest in and capacity for educating nurses in rural areas, is warranted.

This study addresses this important gap, using a national survey of RN-to-BSN programs to better understand the potential role of these programs in addressing disparities in BSN-prepared nurses between rural and urban areas. These results are needed to inform policy makers and stakeholders who are responsible for addressing the status and needs of nursing education.

Method

Study Population

A survey was mailed to all RN-to-BSN program directors in the United States in 2018, using a mailing list of accredited programs obtained from the AACN (N = 758). Three mailings were conducted that included a cover letter, the survey, and a preaddressed stamped envelope for survey return. The survey also included an online completion option using a website or QR code for mobile devices. Fifteen duplicate responses were received, with only the first response retained.

Responses were submitted by 247 of the 758 RN-to-BSN programs, yielding a survey response rate of 32.6%. Ten surveys were dropped either when respondents noted that the RN-to-BSN program had been dropped or had zero enrollment, or when program data were incomplete or missing. The final sample included 237 responses, for a survey completion rate of 31.3%. This rate is comparable to the response received for the previous survey of programs (McEwen et al., 2012). Physical location of the program in a rural versus urban area was not established for the study.

Survey Instrument

Survey development was based on prior literature about RN-to-BSN programs, as well as an informed review by a panel of external nurse educators. These educators were recruited to review draft questions and provide content suggestions and recommendations. The survey addressed overall characteristics of RN-to-BSN programs, as well as their interest in and capacity for serving rural nursing students. Overall characteristics queried included general program information (e.g., institution type, size of program) and program requirements (e.g., student time to completion, grade point average requirements).

Under the subhead “About Your Program and Rural Learners,” program leaders first were asked “Does your program specifically target rural RNs in its recruiting efforts?” with possible responses of “yes” or “no.” Given the educational gaps between rural and urban RNs, the survey design reflected a desire to ascertain the proportion of RN-to-BSN programs with this focus. Subsequent questions addressed the proportion of rural students among all learners, rural health curricular content, student learning challenges, interprofessional education opportunities, and distance learning. Questions about rural-specific curricular content were asked to assess the proportion of programs that were addressing this topic area (Holland et al., 2019). In the areas of recruitment, retention, online learning, and clinical placement, program leaders were asked to evaluate potential student barriers separately for rural and urban learners.

Analyses

Study staff transcribed written questionnaires. Data were exported into Excel® and subsequently analyzed using STATA® version 16. Descriptive statistics were used to report survey findings. Chi-square and one-way ANOVA were used to analyze bivariate results by programs' self-reported status of their efforts to target rural RNs for program recruitment. The study was declared Not Human Subjects research on December 18, 2017, by the University of South Carolina Institutional Review Board.

Results

Characteristics of Programs

RN-to-BSN programs were primarily housed in public university settings (52.7%), followed by private university settings (37.1%; Table 1). In addition to RN-to-BSN program offerings, 176 institutions also offered traditional BSN programs (74.3%), 154 offered Master of Science in Nursing programs (65%), 93 offered PhD/Doctor of Nursing Practice programs (39.2%), and 39 offered Associate Degree in Nursing (ADN) programs (16.5%). Twenty-eight responses for “other programs” included five institutions with a licensed practical nurse/license vocational nurse-to-BSN offering.

Characteristics of RN-to-BSN Programs Responding to Survey

Table 1:

Characteristics of RN-to-BSN Programs Responding to Survey

Current student enrollment in RN-to-BSN programs ranged from 1 to 7,027 students, with a mean of 161 students. Fewer than half of the programs (45.2%) reported a current enrollment of fewer than 50 students, whereas 29.5% of programs reported more than 125 enrolled. The mean number of students accepted annually for the past 5 years was 119 students (range = 2 to 10,150). Only eight programs (3.4%) reported turning down qualified applicants due to a lack of capacity. The mean number of students graduating from RN-to-BSN programs each year was 65 (range = 0 to 1,500). Nearly a quarter of programs (23.3%) reported more than 75 graduates per year. Eighteen programs reported receiving grant funding; of these, 39% reported receiving federal grants, 50% reported state grants, and 28% reported foundation support.

Credit hours required in RN-to-BSN programs ranged from 16 to 120 for nursing hours (median = 31; mean = 38.7), and 0 to 112 for nonnursing hours (median = 42; mean = 41.3). BSN credit hours that were required to be taken at the institution granting the RN-to-BSN degree ranged from 14 to 180 (median = 30; mean = 38.7). Most programs estimated time to completion among full-time students to be 9 to 12 months (43%). Among part-time students, this estimate rose to 19 to 24 months (46.8% of programs). Just more than half of programs required students to complete the RN-to-BSN program in a certain time frame (50.2%). These programs reported a median of 60 months as the maximum time allotment. Minimum GPA requirements for program entrance and maintenance of enrollment were reported by 209 (88.2%) and 200 (84.4%) programs, respectively. Ninety-eight programs (41.4%) reported collaborating with community colleges to offer courses to students.

Regarding the environment of their course delivery, just more than half of programs (50.6%) reported that their course offerings were online only, and 45.2% reported that they were a hybrid program—some courses offered online and some in the classroom setting. Considering only nursing courses required for RN-to-BSN completion, respondents reported 68.4% of the courses were online only, with 27% reporting hybrid course offerings. Approximately two thirds of respondents (65.8%) reported that 100% of their students take online courses each year.

Addressing Rural Learners

Ninety RN-to-BSN programs (38%) reported that they specifically target rural RNs in their student recruitment efforts. Institutions that targeted recruitment of rural RNs to their RN-to-BSN programs were significantly more likely to offer ADN programs compared to those not targeting rural RNs (18.9% versus 13.9%; p = .037; Table 1). Also, programs targeting rural RNs were significantly more likely to report community college collaborations than those that did not (50% versus 36.8%; p < .001).

Program responses regarding the proportion of learners from rural areas was nearly evenly split between the available response categories, with 26.6% of programs reporting fewer than a quarter of their students were from rural communities, 22.4% reporting between a quarter and a half, 25.7% reporting more than half, and the remaining 25.3% of responses either “unable to determine” or left blank (Table 2). Programs reporting that they target recruitment of rural RNs were significantly more likely to report having more than 50% rural students compared to programs not targeting rural RNs (51.1% versus 9.7%; p < .001; Table 2).

RN-to-BSN Programs' Targeting of Rural Learners

Table 2:

RN-to-BSN Programs' Targeting of Rural Learners

Approximately two thirds of all programs indicated that they admitted all qualified rural applicants (n = 154; 65%). Most programs responded either unable to determine or left their answer blank for the proportion of RN-to-BSN students that commute from rural areas (n = 78; 32.9%). This finding was more frequent among programs that did not target rural RNs for recruitment compared with those that did (42.4% versus 16.7%; p < .001). Sixty-eight programs (28.7%) reported that their program is 100% online; 37.8% of these programs targeted rural RNs, whereas 22.9% of these programs did not (p < .001).

Fewer than half of the programs reported offering content intended to specifically prepare students for rural health practice (n = 103, 43.5%; Table 2). Programs targeting recruitment of rural RNs were significantly more likely to respond that they offered this content compared with those that did not target rural RNs (66.7% versus 29.2%, p < .001). This content was primarily offered as part of other courses (68%), but 13 programs offered a full course on rural health (12.6%). Programs that targeted rural RNs were significantly more likely to offer clinical placements in rural communities compared with those that did not (58.3% versus 35.7%; p = .049; Table 2). Twelve programs (5.1%) responded that at least three quarters of their students take a rural health course each year.

Programs' Student Recruitment and Retention Strategies and Barriers

The top three recruitment strategies used by RN-to-BSN programs included recruiting at health care agencies (94.5% of programs), recruiting at schools with other nursing programs (85.2%), and social media (72.6%; Table 3). Recruitment strategies were not different based on the programs' self-reported intention of targeting rural RNs. Most respondents did not differentiate recruitment or retention outcomes based on residence of their students (e.g., rural versus urban), as survey questions asking for rural–urban comparisons resulted in high nonresponse rates. Further, almost one third of programs (30.8%) stated that they do not track student recruits by their home location.

RN-to-BSN Programs' Student Recruitment Methods

Table 3:

RN-to-BSN Programs' Student Recruitment Methods

Barriers to recruitment and retention most often identified by RN-to-BSN program directors were student difficulties in balancing family and work obligations (73% and 72.2%, respectively). Cost of tuition was also reported as a barrier to student recruitment by most programs (56.5%; Table 4). An issue for retention was the ability for students to identify clinical placements, with 24.5% of programs overall reporting difficulty with this. The most common reason for students having issues with finding placements was limited capacity at training sites (16.9%). Student barriers associated with online courses, as reported by program directors, were primarily balancing school, work, and family obligations (80.2% of programs; Table 5). Rural-relevant issues associated with online courses that were reported as challenging for students included poor internet connectivity (26.2% of programs), lack of internet where student resides (15.2%), and lack of affordable internet (10.6%).

Barriers to Student Recruitment for RN-to-BSN Programs, Any Student

Table 4:

Barriers to Student Recruitment for RN-to-BSN Programs, Any Student

Faculty and Student Challenges With Distance Learning Perceived by Directors of RN-to-BSN Programs, Any Student

Table 5:

Faculty and Student Challenges With Distance Learning Perceived by Directors of RN-to-BSN Programs, Any Student

Most programs were able to offer special projects outside of the classroom setting to address rural health needs (55.7%). These included projects that were policy/advocacy oriented (n = 63), community service oriented (n = 107), or other (n = 37). Other responses included, but were not limited to, community assessments or practicums (n = 6), study abroad/mission work (n = 6), community health fairs/clinics (n = 4), and community-based research (n = 3).

Discussion

This study examined the status of RN-to-BSN programs in the United States, specifically focusing on the degree to which programs target and serve rural students. Consistent with previous research, just more than half of the RN-to-BSN programs responding to the study survey were in public universities, and approximately 40% of programs were in private universities (McEwen et al., 2012). This study also confirmed previous findings of small program sizes and common program lengths (McEwen et al., 2012). From the previous study to this one, enrollment of more than 125 students increased from 21% to 29.5%, and more than 75 graduates per year increased from 13% to 23.3% (McEwen et al., 2012). This suggests efforts to increase the number of BSN-prepared nurses are escalating, despite nursing faculty shortages (AACN, 2019c).

The increasing number of BSN-prepared nurses may be due, in part, to employer preferences and/or requirements to hire nurses who have obtained the BSN degree. As of August 2018, nearly 90% of hospitals and other health care providers reported a strong preference for new nursing hires to have a BSN degree, whereas 46% reported having the BSN degree as a requirement for employment (AACN, 2019b). Employers may also have to comply with new state laws that require the BSN degree for new nurses. For example, New York recently enacted a law requiring future nurses to obtain their BSN degree within 10 years of their initial licensure (NY State Senate Bill S6768, 2017).

Advancing education specifically among rural nurses is critical to reducing health disparities between rural and urban populations, yet only 38% of RN-to-BSN programs specifically recruited rural RNs (IOM, 2011). By comparison, 54% of U.S. nurse practitioner (NP) programs reported actively recruiting students from rural areas, despite 92% of their program locations being in urban areas (Skillman et al., 2014). Encouragingly, programs that targeted rural RNs for recruitment more frequently offered ADN programs as well, suggesting the possible recognition of the need for a “pipeline” to BSN studies for rural nursing students.

To increase the overall number of BSN-prepared nurses, the AACN has called for collaborations with community colleges (Conner & Thielemann, 2013). In this study, only 41% of RN-to-BSN programs reported ongoing collaborations with these institutions. Community college partnerships may help decrease the rural-urban BSN disparity, as they are broadly available, cost-effective sources of nursing education in rural areas that have multiple recruiting advantages (AACN, n.d.; Conner & Thielemann, 2013; Diaz Swearingen et al., 2013; Farmer et al., 2017; Hawkins et al., 2018).

Concurrent enrollment models between community colleges and universities may be an effective strategy for producing additional rural BSN graduates. For example, these models may include flexibility that allows students to obtain a nonnursing associate degree while transitioning into a BSN program. One example from Colorado includes introductory nursing courses cotaught by community college and university faculty in both locations during the first year with a transition to the university campus for years 2 and 3 (Goode et al., 2016). These types of collaborations will also be necessary to reach the overall goal of increasing the number of BSN-prepared nurses, as the current level of capacity in baccalaureate nursing education is insufficient to meet the demand (Orsolini-Hain, 2012). To accelerate these efforts, leadership investment from both ADN and BSN programs is needed to provide resources and release time for faculty to cocreate seamless academic progression programs. Mutual respect, trust, and facilitative communication strategies are needed to nurture innovation among program leaders.

Academic-practice partnerships may also be effective for increasing the number of BSN-prepared nurses in rural areas, and they may be necessary where employers and/or states require the BSN degree. Some universities are responding to the greater demand for BSN-prepared nurses by offering even more flexibility in helping RNs who desire to pursue a BSN degree. These universities may offer online course options, as well as programs that can be completed face-to-face at work in local health care or technical college facilities and/or in competency-based programs that do not have strict time constraints, awarding the BSN degree after demonstration of mastery (Litwack & Brower, 2018). Competency-based programs especially allow universities the opportunity to engage their local health care partners to ensure program success, as well as to develop new competencies (e.g., interdisciplinary education) that become necessary as a result of health care reform (Orsolini-Hain, 2012). Collaboration between ADN and BSN programs and practice partners on a competency-based program model can result in a seamless academic progression that focuses on standardizing learning outcomes for nurses seeking the BSN degree (Carissimi & Burger, 2017).

Another flexible approach used by nurse educators in Alabama allows ADN-prepared nurses to participate in a rural regional medical center's BSN nurse residence program (Cheshire et al., 2017). A goal of this partnership is to incentivize nurses to pursue the BSN degree by allowing them to complete activities and assignments that align with shared objectives of the residency and RN-to-BSN programs. As reported by Cheshire et al. (2017), the program has been highly successful, with nearly 30 nurses completing both programs and an additional 25 nurses recruited for the RN-to-BSN program. This type of program demonstrates the potential benefit of academic–practice partnerships for a rural facility, which can use these models to “grow their own,” thereby saving on recruitment and staff turnover costs in the future. For rural and underserved areas, academic–practice partnerships are a powerful amalgam that are properly aligned and incentivized to improve health care with the greatest potential impact on vulnerable populations.

These partnerships may also address barriers for rural learners that occur because of a limited availability of placements at rural clinical sites. Approximately one quarter of RN-to-BSN programs reported that clinical placements were difficult in rural communities. Substituting clinical time with simulated patient care experiences may be another viable strategy to bolster clinical placement sites in rural areas, given evidence that replacing up to 50% of traditional nursing clinical hours with simulation does not adversely affect education outcomes (Hayden et al., 2014). However, guidelines for implementing simulation-based educational experiences may be difficult for programs targeting rural nurses to achieve due to costs or lack of appropriate facilities (Alexander et al., 2015). State boards of nursing should carefully consider the resource needs of rural nursing education when adopting policies or advocating for legislation that supports simulated patient care experiences.

Online RN-to-BSN programs could increase educational access for rural nurses by reducing barriers such as long driving distances to campus. In the previous survey of programs, those that were exclusively online accounted for 24% of responses; in the current study, this number increased to 29% (McEwen et al., 2012). Growth in online content was also indicated by an increase from two thirds of courses offered in a hybrid format in the previous study to nearly all programs (n = 227; 95.8%) reporting these offerings in this study. This is an expected finding given that, at the time of the previous survey, programs had reported plans to expand their efforts in this area (McEwen et al., 2012).

However, online coursework is not without its challenges. Commonly cited barriers for students and educators in this study were limited information technology (IT) skills and the lack of IT assistance after hours. Limited student computer literacy has been previously reported by other RN-to-BSN programs (McEwen et al., 2013; Spencer, 2008). Lack of IT assistance may be especially problematic for rural nursing students, as broadband capacity is less available in rural areas (Hawkins et al., 2018; Prieger, 2013). Poor internet connectivity was cited as a barrier for students by just more than a quarter of programs in this study. Quality of online-only programs may also be a concern, although similar educational outcomes have been found in studies comparing on-campus and online RN-to-BSN programs (Mancini et al., 2015; McEwen et al., 2013). Mitigating barriers to online education is another strategy that RN-to-BSN programs may consider to recruit and retain rural learners.

More than half of the directors reported program cost as a barrier to student recruitment, as seen in Table 4. BSN programs are often very expensive, and financial burden is a reason commonly cited among nurses for not finishing their BSN degree (Duffy et al., 2014; Spetz & Bates, 2013). Low salaries among rural nurses may also be a contributing factor (Lindeke et al., 2005). Further, RN-to-BSN programs specifically have high attrition rates due to the time commitment needed for program completion (Jones-Schenk, 2017). The tradeoffs in time and cost can be demotivating for nurses, especially when employers reportedly do not guarantee more pay for the higher degree level (Diaz Swearingen et al., 2013; McEwen et al., 2013). Policies that assist rural nurses in furthering their education may include loan repayment programs for rural practice (HRSA, n.d.). Nurses may also benefit from employer policies that allow them to transition to part-time work with full-time benefits while pursuing further education (Warshawsky et al., 2015). Accessible financial support in the form of scholarships and loan repayments has been shown to promote enrollment and retention (Conner & Thielemann, 2013; Hawkins et al., 2018; Skillman et al., 2014; Swearingen et al., 2013).

Strengths and Limitations

This study was limited in targeting only program directors that were identified by a list obtained from the AACN. However, as the major body representing nursing schools, this was the most likely source of survey respondents available. Physical location of programs in rural or urban areas was not available for analysis. Further, survey participants were not provided a definition of rural to consider when reporting on their targeting of those students. However, when definitions of online and hybrid course offerings were provided, unclear responses were received. Strengths included the national scope of the survey and the examination of RN-to-BSN programs' targeting of rural learners, the latter of which has not been examined in prior literature.

Conclusions

With relatively few existing RN-to-BSN programs targeting and serving rural learners, the recommendation of the BSN as entry to professional nursing practice may be problematic for many rural nurses. Policy makers, educators, and stakeholders must collaborate to support these programs and other policies that assist and incentivize rural nurses to continue their education. Further, all nursing programs should be encouraged to target, recruit, and retain rural students, as well as provide specific rural training opportunities for all students. These findings give stakeholders a starting point on strategies to use to increase recruitment and retention of potential rural RN-to-BSN students. Ultimately, more rural RN-to-BSN graduates will lead to higher education levels among rural nurses and may improve patient outcomes among rural populations.

References

  • Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., Maier, C. B., Moreno-Casbas, T., Ball, J. E., Ausserhofer, D., Sermeus, W., Van Den Heede, K., Lesaffre, E., Diya, L., Smith, H., Jones, S., Kinnunen, J., Ensio, A., Jylhä, V. & Van Achterberg, T.the RN4CAST Consortium. (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 26, 559–568 doi:10.1136/bmjqs-2016-005567 [CrossRef] PMID:28626086
  • Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P. R., Goldman, N., Kardong-Edgren, S., Kesten, K. S., Spector, N., Tagliareni, E., Radtke, B. & Tillman, C. (2015). NCSBN simulation guidelines for prelicensure nursing programs. Journal of Nursing Regulation, 6(3), 39–42 doi:10.1016/S2155-8256(15)30783-3 [CrossRef]
  • American Association of Colleges of Nursing. (n.d.). Academic progression in nursing: Moving together toward a highly educated nursing workforce. https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Academic-Progression-in-Nursing
  • American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. http://www.aacnnursing.org/portals/42/publications/baccessentials08.pdf
  • American Association of Colleges of Nursing. (2019a). Associate degree in nursing programs and AACN's support for articulation. https://www.aacnnursing.org/News-Information/Fact-Sheets/ADN-Facts
  • American Association of Colleges of Nursing. (2019b). Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses. http://www.aacnnursing.org/Portals/42/News/Position-Statements/Research-Brief-2-19.pdf
  • American Association of Colleges of Nursing. (2019c). Fact sheet: Nursing faculty shortage. https://www.aacnnursing.org/Portals/42/News/Factsheets/Faculty-Shortage-Factsheet.pdf
  • Baernholdt, M. & Mark, B. A. (2009). The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Journal of Nursing Management, 17, 994–1001 doi:10.1111/j.1365-2834.2009.01027.x [CrossRef] PMID:19941573
  • Barton, B. & Azam, I. (2017). National healthcare quality and disparities report: Chartbook on rural health care. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/qdr-ruralhealthchartbook-update.pdf
  • Bratt, M. M., Baernholdt, M. & Pruszynski, J. (2014). Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme. Journal of Nursing Management, 22, 779–791 doi:10.1111/j.1365-2834.2012.01483.x [CrossRef] PMID:25208945
  • Carissimi, K. & Burger, J. (2017). Bridging the gap: Seamless RN to BSN degree transitions. The Online Journal of Issues in Nursing, 22(2).
  • Cheshire, M. H., Ford, C. D. & Daidone, Y. (2017). An innovative academic/service partnership to increase BSN-prepared RNs in a rural hospital. The Journal of Nursing Administration, 47(7–8), 376–378 doi:10.1097/NNA.0000000000000498 [CrossRef] PMID:28727622
  • Conner, N. E. & Thielemann, P. A. (2013). RN-BSN completion programs: Equipping nurses for the future. Nursing Outlook, 61, 458–465 doi:10.1016/j.outlook.2013.03.003 [CrossRef] PMID:23618550
  • Cramer, M., Duncan, K., Megel, M. & Pitkin, S. (2009). Partnering with rural communities to meet the demand for a qualified nursing workforce. Nursing Outlook, 57, 148–157 doi:10.1016/j.outlook.2008.09.007 [CrossRef] PMID:19447235
  • Diaz Swearingen, C., Clarke, P. N., Gatua, M. W. & Sumner, C. C. (2013). Diffusion of a nursing education innovation: Nursing workforce development through promotion of RN/BSN education. Nurse Educator, 38(4), 152–156 doi:10.1097/NNE.0b013e318296dd26 [CrossRef] PMID:23778044
  • Duffy, M. T., Friesen, M. A., Speroni, K. G., Swengros, D., Shanks, L. A., Waiter, P. A. & Sheridan, M. J. (2014). BSN completion barriers, challenges, incentives, and strategies. The Journal Of Nursing Administration, 44(4), 232–236 doi:10.1097/NNA.0000000000000054 [CrossRef] PMID:24662693
  • Farmer, P., Meyer, D., Sroczynski, M., Close, L., Gorski, M. S. & Wortock, J. (2017). RN to BSN at the community college: A promising practice for nursing education transformation. Teaching and Learning in Nursing, 12, 103–108. doi:10.1016/j.teln.2016.12.003 [CrossRef]
  • Goode, C. J., Preheim, G. J., Bonini, S., Case, N. K., VanderMeer, J. & Iannelli, G. (2016). The integrated nursing pathway: An innovative collaborative model to increase the proportion of baccalaureate-prepared nurses. Nursing Education Perspectives, 37(2), 110–112 PMID:27209872
  • Hawkins, J. E., Wiles, L. L., Karlowicz, K. & Tufts, K. A. (2018). Educational model to increase the number and diversity of RN to BSN graduates from a resource-limited rural community. Nurse Educator, 43(4), 206–209 doi:10.1097/NNE.0000000000000460 [CrossRef] PMID:28991030
  • Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S. & Jeffries, P. R. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S1–S64 doi:10.1016/S2155-8256(15)30062-4 [CrossRef]
  • Health Resources and Services Adminstration Bureau of Health Professions National Center for Health Workforce Analysis. (2013). The U.S. nursing workforce: Trends in supply and education. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nursingworkforcetrendsoct2013.pdf
  • Health Resources and Services Adminstration Bureau of Health Workforce. (n.d.). Nurse corps. https://bhw.hrsa.gov/loans-scholarships/nurse-corps
  • Holland, A., Selleck, C., Deupree, J., Hodges, A., Shirey, M., Blakely, K., Plane, L. C. & Harper, D. C. (2019). A curriculum to expand rural health care access. The Journal for Nurse Practitioners, 15(4), e69–e72 doi:10.1016/j.nurpra.2018.12.021 [CrossRef]
  • Institute of Medicine. (2010). The future of nursing: Focus on education. http://www.nationalacademies.org/hmd/∼/media/Files/ReportFiles/2010/The-Future-of-Nursing/NursingEducation2010Brief.pdf
  • Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. https://www.ncbi.nlm.nih.gov/books/NBK209880/pdf/Bookshelf_NBK209880.pdf
  • Jones-Schenk, J. (2017). Co-creating a movement. The Journal of Continuing Education in Nursing, 48(10), 442–444 doi:10.3928/00220124-20170918-03 [CrossRef] PMID:28954178
  • Lindeke, L., Jukkala, A. & Tanner, M. (2005). Perceived barriers to nurse practitioner practice in rural settings. The Journal of Rural Health, 21(2), 178–181 doi:10.1111/j.1748-0361.2005.tb00079.x [CrossRef] PMID:15859056
  • Litwack, K. & Brower, A. M. (2018). The University of Wisconsin–Milwaukee flexible option for bachelor of science in nursing degree completion. Academic Medicine, 93(3S), S37–S41 doi:10.1097/ACM.0000000000002076 [CrossRef] PMID:29485486
  • Mancini, M. E., Ashwill, J. & Cipher, D. J. (2015). A comparative analysis of demographic and academic success characteristics of on-line and on-campus RN-to-BSN students. Journal of Professional Nursing, 31, 71–76 doi:10.1016/j.profnurs.2014.05.008 [CrossRef] PMID:25601248
  • McEwen, M., Pullis, B. R., White, M. J. & Krawtz, S. (2013). Eighty percent by 2020: The present and future of RN-to-BSN education. Journal of Nursing Education, 52(10), 549–557 doi:10.3928/01484834-20130913-01 [CrossRef] PMID:24040770
  • McEwen, M., White, M. J., Pullis, B. R. & Krawtz, S. (2012). National survey of RN-to-BSN programs. Journal of Nursing Education, 51(7), 373–380 doi:10.3928/01484834-20120509-02 [CrossRef] PMID:22588566
  • National Advisory Council on Nurse Education and Practice. (2010). Addressing new challenges facing nursing education: Solutions for a transforming healthcare environment. https://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/eighthreport.pdf
  • New York State Senate Bill S6768. (2017). https://legislation.nysenate.gov/pdf/bills/2017/S6768
  • Orsolini-Hain, L. (2012). The Institute of Medicine's Future of Nursing Report: What are the implications for associate degree nursing education?Teaching and Learning in Nursing, 7(2), 74–77 doi:10.1016/j.teln.2011.11.003 [CrossRef]
  • Prieger, J. E. (2013). The broadband digital divide and the economic benefits of mobile broadband for rural areas. Telecommunications Policy, 37(6–7), 483–502 doi:10.1016/j.telpol.2012.11.003 [CrossRef]
  • Probst, J. C., McKinney, S. H. & Odahowski, C. (2019). Rural registered nurses: Educational preparation, workplace, and salary. https://www.sc.edu/study/colleges_schools/public_health/research/research_centers/sc_rural_health_research_center/documents/ruralregisterednurses.pdf
  • Skillman, S. M., Kaplan, L., Andrilla, C. H. A., Ostergard, S. & Patterson, D. G. (2014). Support for rural recruitment and practice among U.S. nurse practitioner education programs. http://depts.washington.edu/uwrhrc/uploads/RHRC_PB147_Skillman.pdf
  • Skillman, S. M., Palazzo, L., Keepnews, D. & Hart, L. G. (2006). Characteristics of registered nurses in rural versus urban areas: Implications for strategies to alleviate nursing shortages in the United States. The Journal of Rural Health, 22(2), 151–157 doi:10.1111/j.1748-0361.2006.00024.x [CrossRef] PMID:16606427
  • Smith, J. G., Plover, C. M., McChesney, M. C. & Lake, E. T. (2019). Isolated, small, and large hospitals have fewer nursing resources than urban hospitals: Implications for rural health policy. Public Health Nursing, 36, 469–477 doi:10.1111/phn.12612 [CrossRef] PMID:30957926
  • Southwest Minnesota State University. (n.d.). RN to BSN. https://www.smsu.edu/academics/programs/rntobsn/index.html
  • Spencer, J. (2008). Increasing RN-BSN enrollments: Facilitating articulation through curriculum reform. The Journal of Continuing Education in Nursing, 39(7), 307–313 doi:10.3928/00220124-20080701-12 [CrossRef] PMID:18649806
  • Spetz, J. & Bates, T. (2013). Is a baccalaureate in nursing worth it? The return to education, 2000–2008. Health Services Research, 48(6), 1859–1878 doi:10.1111/1475-6773.12104 [CrossRef] PMID:24102422
  • U.S. Department of Health and Human ServicesHealth Resources and Services AdministrationBureau of Health Workforce National Center for Health Workforce Analysis. (2019). Brief summary of results from the 2018 national sample survey of registered nurses. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/nssrn-summary-report.pdf
  • Warshawsky, N. E., Wiggins, A. T., Lake, S. W. & Velasquez, C. (2015). Achieving 80% BSN by 2020: Chief nurse executive role and ANCC influence. Journal of Nursing Administration, 45(11), 582–588 doi:10.1097/NNA.0000000000000267 [CrossRef] PMID:26492151

Characteristics of RN-to-BSN Programs Responding to Survey

CharacteristicAll Programs (N = 237)Targets Rural RNs for Recruitment (n = 90)Does Not Target Rural RNs for Recruitment (n = 144)p-Value
Institution type.209
  Public university52.7%56.7%49.3%
  Private university37.1%32.2%41%
  Community or technical college5.1%7.8%3.5%
  Public medical center0.8%2.2%0%
  Private medical center0.8%0%1.4%
  Other/missing/blank3.4%1.1%4.9%
Programs offereda
  RN-to-BSN100%38%60.8%
  BSN74.3%72.2%75.7%.802
  MSN65%60%68.8%.202
  PhD/DNP39.2%33.3%43.1%.326
  ADN16.5%18.9%13.9%.037b
  LPN/LVN6.3%10%4.2%.184
  Other11.8%7.8%14.6%.238
Mean number of students currently161.1 (502.3)193.0 (748.0)139.7 (253.2).672
enrolled (± SD)
Mean number of students accepted119.3 (672.5)178.2 (1,077.7)80.4 (138.8).480
on average past 5 years (± SD)
Mean number of students graduating65.2 (145.0)63.6 (167.4)65.6 (129.8).839
each year (± SD)
Collaborate with community colleges<.001b
  Yes41.4%50%36.8%
  No57.8%50%63.2%
  Missing/blank0.8%0%0%

RN-to-BSN Programs' Targeting of Rural Learners

CharacteristicAll Programs (N = 237)Targets Rural RNs for Recruitment (n = 90)Does Not Target Rural RNs for Recruitment (n = 144)p-Value
RN-to-BSN students from rural communities<.001b
  <25%26.6%14.4%34.7%
  25 to 50%22.4%25.6%20.8%
  >50%25.7%51.1%9.7%
  Unable to determine/missing/blank25.3%8.9%34.7%
Qualified applicants from rural communities not admitted due to lack of capacity<.001b
  Admitted all rural applicants65%86.7%52.1%
  Did not admit this percent of our rural applicants1.7%2.2%1.4%
(0.25% to 1%)
  Unable to determine/missing/blank33.3%11.1%46.5%
RN-to-BSN students commuting from rural communities<.001b
  <25%22.4%18.9%25%
  25 to 50%5.9%6.7%5.6%
  >50%10.1%20%4.2%
  Program is 100% online28.7%37.8%22.9%
  Unable to determine/missing/blank32.9%16.7%42.4%
Offer content that specifically prepares for rural health practice<.001b
  Yes43.5%66.7%29.2%
  No55.7%33.3%70.8%
  Missing/blank0.8%0%0%
If yesa:
  Rural health content included in other courses68%60%78.6%.111
  Clinical placements in rural48.5%58.3%35.7%.049b
  Full course on rural health12.6%13.3%11.9%.909
  Other12.6%15%9.5%.664

RN-to-BSN Programs' Student Recruitment Methods

Recruitment MethodaAll Programs (N = 237)Targets Rural RNs for Recruitment (n = 90)Does Not Target Rural RNs for Recruitment (n = 144)p Value
Recruiting at health care agencies (e.g., hospitals, long term care facilities)94.5%94.4%95.1%.100
Recruiting at schools with other nursing programs (e.g., ADN, LPN)85.2%84.4%85.4%.753
Social media72.6%74.4%71.5%.865
Open houses (at own institution)70%72.2%69.4%.340
Recruiting at conferences59.1%65.6%55.6%.210
Formal partnerships with health care agencies (e.g., tuition reimbursement, reduced tuition for employees)57%60%55.6%.566
Formal partnerships with other agencies/employers29.5%34.4%26.4%.417
Formal partnerships with the Veterans7.2%10%5.6%.391
Administration
Other17.7%15.6%18.8%.639

Barriers to Student Recruitment for RN-to-BSN Programs, Any Student

Potential BarrieraAll Programs (N = 237)
Family obligations of prospective students73%
Work obligations of prospective students72.2%
Cost of tuition56.5%
Required nonnursing courses46%
Lack of tuition reimbursement by employers42.2%
Lack of student loan forgiveness programs36.3%
Length of time to degree completion22.4%
Lack of preferential hiring of BSN-prepared nurses21.1%
Distance prospective students must travel12.2%
Lack of capacity (e.g., shortage of nurse faculty or clinical sites for training)6.3%
Other11%

Faculty and Student Challenges With Distance Learning Perceived by Directors of RN-to-BSN Programs, Any Student

Potential ChallengeaFaculty, All Programs (N = 237)Students, All Programs (N = 237)
Campus IT assistance unavailable after hours29.1%27.4%
Limited IT skills26.2%46.8%
Poor internet connectivity16.9%26.2%
Faculty disinterest in teaching in an online environment12.7%
Cost of online course delivery platforms10.1%
Difficulty balancing school/work/family80.2%
Poor academic preparation31.2%
Lack of internet where students reside15.2%
Lack of computer ownership by students11%
Student disinterest in taking courses offered online10.6%
Lack of affordable internet access10.6%
Other17.3%3.4%
Authors

Dr. Merrell is Research Assistant Professor, Dr. Probst is Director Emerita, and Dr. Haynes is Research Associate, Rural and Minority Health Research Center, Dr. Crouch is Assistant Professor, Department of Health Services Policy and Management, Dr. Abshire is Assistant Professor, and Dr. McKinney is Associate Professor, College of Nursing, University of South Carolina, Columbia, South Carolina.

This study was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement number U1CRH30539 (Dr. Probst, Dr. Abshire, and Dr. McKinney). Additional support was received from the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number K23MD013899 (Dr. Abshire). The information, conclusions, and opinions expressed in this article are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Melinda A. Merrell, PhD, MPH, Research Assistant Professor, Rural and Minority Health Research Center, University of South Carolina, 220 Stonebridge Drive, Suite 204, Columbia, SC 29210; email: mmerrell@mailbox.sc.edu.

Received: February 18, 2020
Accepted: June 08, 2020

10.3928/01484834-20200921-04

Sign up to receive

Journal E-contents