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Examining
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| Illustrations by Malcolm Garris/PhotoDisc |
By
Barbara Bronson Gray,
MN, RN How long does it take to finish a two-year nursing program in California? The answer’s not what you think. The typical community college program takes three years—or more. As nursing leaders and policy-makers debate how to best educate future nurses and as the nursing shortage heats up, that issue is more critical than ever before. And what community college deans and directors across California are saying is crystal clear: There’s really no such thing as a two-year nursing program. The problem is not waiting lists or trouble getting the right classes, although students have to cope with those additional factors at some institutions. But most community college programs have about 20 semester units of required courses in science and other subjects—which usually take about a year to complete—before a student even begins the nursing program’s two-year curriculum. Credit doesn’t transfer While the average community college student who is not studying nursing needs only about 60 units of semester credits to earn the associate of arts (AA) degree, nursing students typically must have 72 or more units. Since many of those additional units are not transferable to four-year colleges and universities, students who seek a bachelor’s degree in nursing after an AA can face up to three or four years of further study. "It’s called curriculum creep," said Charlotte Erdahl, MS, RN, director of the nursing program and dean of health, public services, and physical education at Southwestern College in Chula Vista, California. "I don’t know of any community college program in nursing that you can do in two years." Erdahl estimates that among the state’s 71 AA nursing programs, the average number of required units is 80, which take at least three years to complete. Yet the California State University system will allow no more than 70 units to be transferred as credit toward a bachelor’s degree, according to Dixie Bullock, MN, RN, director of the nursing program at Saddleback College in Mission Viejo. So prerequisite courses exceeding the 70-unit cutoff fall into a bottomless pit and cannot be applied to the bachelor’s degree credit requirement, according to Bullock. And that’s not all Some nursing programs are building in additional prerequisites on top of the typical anatomy, physiology, microbiology, and English courses. At Southwestern, entering nursing students must now be certified nursing assistants before school admission. "We need graduates who know the role of the nursing assistant so they can delegate, and it helps screen our waiting list and eliminate those who are not really interested in nursing," Erdahl said. At Santa Ana College, students must take anatomy and physiology, microbiology, speech, and English before they can be placed on the 200-person nursing program waiting list. "It’s the bare bones," said Carol Comeau, MSN, RN, director of nursing and health sciences. Even with these prerequisites, she said, "the associate degree is pretty streamlined." Quality or a rip-off? While some see the time it takes for students to complete an AA in nursing as a sign of the degree’s quality, others feel it’s a higher education rip-off, since it takes almost as long to get an AA degree in nursing as it does to get a bachelor’s. "The state subsidizes community colleges, and if the state is subsidizing more than two years for the AA degree, taxpayers are supporting units that need to be re-earned at an upper-division level someplace else," said Marjorie Barter, EdD, RN, associate professor at the University of San Francisco. Remedial work can also lengthen the time nurses spend in associate-degree programs. "The student population presenting at the door of the community college is less prepared for college work than ever before," said Linda Stevens, MSN, RN, dean for the health professions at Golden West College in Huntington Beach, California. Yet many nursing vice presidents and directors say that the community college system turns out some of the best bedside nurses, no matter how long it may take for them to graduate. In some areas, community college deans say their students are in greater demand than state university graduates with bachelor’s degrees. More or less You might think accredited programs would require more units, but that’s not so. Programs that don’t seek accreditation from the National League for Nursing Accreditation Center often require even more units for an AA degree, up to even 90 units, according to AA program directors. The NLNAC insists that AA programs require no more than 72 semester units. According to NLNAC Executive Director Geraldene Felton, EdD, RN, FAAN, the newly enforced 72-unit maximum was implemented because the accrediting agency was concerned about "integrity." "I bemoan the need to drop what I consider to be good courses," Felton said. But the NLNAC doesn’t think it’s fair to require so much time for a two-year degree. "We get the most complaints about associate-degree programs; the faculty tries to push everything they ever learned into the associate-degree curriculum." About 1,700 nursing programs nationwide are accredited by the New York-based NLNAC, which reviews about 200 vocational, associate degree, diploma, bachelor’s and master’s programs, and schools a year, Felton said. Less than half the AA programs in California are NLNAC-accredited. (Enrollment in an NLNAC-accredited program is required for some federal financial aid, for admission to many colleges and universities, and by the armed forces.) Planning for the future As the difference in time it takes to receive an AA degree and a bachelor’s degree narrows, the debate about how to educate California’s nurses in the next century could change. Some argue that, after all, for two or three more semesters of work, these students could have a bachelor’s degree. The stakes are high. A federally funded University of Michigan study by the Institute for Social Research in Ann Arbor, found that in 1994, household heads with a bachelor’s degree earned $22,134 more a year (in 1996 dollars) than did those with only some college. The study found that the financial value of higher education increased in the mid-1990s, and those with a bachelor’s degree saw their incomes rise significantly more than did those without one. In the same period, the National Center for Education Statistics found that women earned 21 percent more bachelor’s degrees than did men, up from 14 percent more five years earlier. Yet in nursing, which is predominantly a female profession, the number of those earning a bachelor’s degree has not risen significantly. And Felton says that by 2010, fewer than 50 percent of nurses nationwide will have a bachelor’s degree. Working toward change Solutions aren’t simple. Bullock says the community college and state university systems need to change to allow students to take the pre-nursing curriculum at the community college level and the clinical courses and upper-division work at a state university. She also thinks the funding discrepancies between the community college system—which gets $3,100 per full-time student per year—and the state university system—which gets $7,000 per student—need to be re-evaluated. There are also scores of legislated rules that hamstring the community colleges, according to many community college program directors. "There are more laws in California’s education code than Arizona has governing the entire state," said Sharlene Limon, MS, RN, division dean for health sciences at Ohlone College in Fremont. Most education experts say that until the issues get ironed out in higher education, what future nursing students mainly need is good advice. "Most important is appropriate counseling for students when they start," Comeau said. |
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A CASE
Study Many community colleges are adding home health and community health experience to the curriculum. At Ohlone College in Fremont, California, they’ve added community health, but removed advanced medical/surgical content and cut gerontology/psychology and maternal/child courses to only nine-week courses each, said Sharlene Limon, MS, RN, division dean for health sciences. The American Association of Colleges of Nursing released a new vision statement earlier this year, calling for expanded bachelor’s degree curricula for the new century. The association argues that in addition to continuing to focus on acute and tertiary care, nursing education must include primary health care, patient education, health promotion, rehabilitation, and alternative methods of healing. |
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A SNAPSHOT There are 71 community college nursing programs in California; 30 are accredited by the National League for Nursing Accreditation Center (NLNAC). Here’s a rundown of just how many units are needed and by whom: Average
number of units required by community college nursing programs in the
state Number
of units transferable to the Cal State University system Number
of units required by the BRN Minimum
required for NLNAC accreditation Maximum allowed by NLNAC for accreditation 72 |
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A SHOPPING List Ask for precise information on the number of required units, average length of time the program takes, and the number of units directly transferable to the state university or other college system. Learn what courses are required before admittance to the nursing program. Compare the time and course work required for community college work to that of bachelor’s programs. Talk with state university nursing programs to see which community colleges offer the best fit—often called articulation—with their requirements. When comparing the cost of an AA program and a bachelor’s program, consider the time and financial investment required to get the bachelor’s degree after completion of the AA degree. Find out how realistic it is to plan to work part time while pursuing the course and clinical work in the nursing program. |
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SPEAK
Out What do you think? |