Nursing A Health Care Shortage
It’s tucked behind a sprawling, fenced complex of General Services Administration warehouses, past a series of nondescript office buildings and car dealerships, adjacent to one of the busiest stretches of highway leading into the nation’s capital.
It is also located at the forefront of efforts by community colleges to train dental hygienists, physical therapists, diagnostic and laboratory technicians and especially nurses — health care workers who are in increasingly short supply.
“This is a response to a perfect storm of demographics,” said Interim Provost Brian Foley. “The population is getting older, requiring more acute care. The providers are getting older and retiring. The health care worker shortage is not just a health care crisis, it is a community crisis.”
And the campus is more than a mere community college. It is also the focal point of the Northern Virginia Health Care Workforce Alliance, a rare collaboration of federal, state and local governments and local business groups, hospitals and institutions of higher education.
The alliance is striving to make a dent in projected shortages in the regional health care workforce. By 2020, it’s estimated the region will need 16,000 nurses, 1,000 physical therapists, 600 occupational therapists and 800 mental health counselors.
The alliance is doing its part to provide more health care workers. The NVCC medical campus is equipped not only with traditional laboratories and classrooms, but also clinics where local residents can get cuts stitched by supervised trainees. There is a fully equipped hospital ward and operating room. It has been praised by PricewaterhouseCoopers’ Heath Research Institute as a model program for increasing the supply of health care workers.
Filling the Gap
Across the country, community colleges are scrambling to fill projected shortages of health care workers. They have been doing so for years. Nationwide, there are more than 800 programs offering an associate degree in nursing.
In Florida, Miami Dade College recently announced the receipt of an $11 million gift from the Mitchell Wolfson Sr. Foundation to increase the supply of nurses in South Florida. Bucks County Community College outside Philadelphia recently announced plans for a new building to increase the college’s capacity to train nurses.
The need for the recent expansions is clear. According to the federal Bureau of Labor Statistics, employment of registered nurses will increase by 23 percent between 2006 and 2016, the highest growth rate of any occupation tracked by the agency. The Health and Human Resources Administration projects that without aggressive education programs, the supply of nurses in the U. S. will fall 36 percent behind the requirements by 2020.
For decades, community colleges have responded to the shortage by bolstering nursing education programs and expanding their capacity through collaborations with hospitals, distance learning, evening programs and the use of simulators in place of expensive clinical settings.
According to the American Association of Community Colleges, associate degree programs educate about 60 percent of all registered nurses. Nearly half of all registered nurses caring for patients in long-term care setting practice with an associate degree.
Yet even as community colleges turn out increasing numbers of nurses, questions persist about whether an associate degree is adequate for nurses practicing in today’s increasingly technical and complex medical settings. Though this is a debate with roots that stretch back 40 years, it has gained new currency as colleges strive to respond to the looming shortages.
“Community colleges are doing yeoman’s work in training nurses, especially workers in areas where others are not,” said Beverly Malone, chief executive officer of the National League of Nursing. “But I do want to stress that I believe that nurses today require more training. We need nurses who are as well-prepared as possible.”
The NLN is among nursing organizations backing a proposal being considered by the New York legislature that would require nurses graduating with an associate degree to complete a four-year bachelor’s degree programwithin 10 years of obtaining their license. A similar effort is afoot in New Jersey.
Advocates of such proposals argue that among major licensed heath-care professions, the registered nurse is the only one that accepts an associate degree for an entry-level position. They note that positions such as athletic trainers and physical therapists require bachelor’s degrees, and fields such as occupational therapy generally require master’s degrees.
The American Association of Colleges of Nursing contends that having nurses prepared at the bachelor’s degree level means better patient care. An AACN fact sheet cites data that shows lower mortality rates, fewer medication errors and more positive outcomes when nurses are prepared at the baccalaureate and master’s level compared to the associate degree level.
Mary Jean Schumann, chief programs officer for the American Nurses Association, said there is growing body of evidence that nurses with bachelor’s degrees perform better than those with associate degrees.
“There have been studies that show that bachelor’s degree level nurses provide better care, and can care for more patients at the same time,” she said. “The education of nurses is getting more complex, and it’s a lot to pack into two years. With the science and math that are required, it is a huge chore.”
But groups such as the National Organization for Associate Degree Nursing believe that requiring a bachelor’s degree would exacerbate the nursing shortage by robbing potential nurses of an important path into health care careers.
The group’s president, Donita Qualey, recently said that for nurses who aspire only to provide bedside care, an associate degree is acceptable. Higher education requirements should be confined to students who want to teach or go into management, she said.
The AACC, meanwhile, dispute whether associate degree nurses are less-qualified than their bachelor’s degree-holding counterparts. Significantly, both groups must pass an identical test to obtain a license. They pass the exam at roughly the same rate and are authorized to provide the same level of care.
In addition, associate degree nurses are considered a good economic investment. They provide a supply of nurses to rural areas, which are underserved and where local graduates are likely to remain after they earn their degrees.
Nearly everyone involved in the debate agrees that more nurses who hold an associate degree need to further their education. Currently, only about 21 percent of associate degree nurses go on to obtain a bachelor’s degree, according to the AACC.
Over the long term, that number contributes to a shortage of qualified nursing instructors, said Malone, head of the NLN.
“We have a problem in that people are not going back to college,” she said. “What we really need is faculty. You have to look at today’s faculty. They are getting older. We have to teach our students how to teach.”
Northern Virginia Community College is collaborating with George Mason University to steer more nursing students toward bachelor’s degrees. The “Momentum 2 + 1” program allows students to complete a bachelor’s degree in nursing in three years instead of four.
Students enrolled in the program spend their first two years enrolled in community college, earning two associate degrees, one in nursing and one in general studies. Once their associate degrees are completed, they can take the exam to become a registered nurse and also qualify for admission to Mason, where they complete the third and final year of their studies.
While defending associate degree programs, the AACC is also calling for more federal dollars to be directed to community colleges so they can bolster their offerings. Community colleges only collected 6 percent of the $106 million in federal grant money distributed to nursing schools in fiscal year 2006.
Schumann said she favors seamless collaborations between associate and bachelor degree programs.
“The public and the community need to do better job in making sure all the pieces fit together,” she said. “We can’t have people wasting their precious time.”
She added the bottom line is that nurses with associate degrees need to devote themselves to lifelong learning and professional development.
“Our message is ‘let’s get people educated, and let’s keep them going.’”