When Heather Kaz was a child, she made IVs out of twigs for her dolls. As a 5-year-old, she helped her grandmother, a World War II nurse, take care of her ailing grandfather. As far as she could remember, nursing had been an important part of her life. So it seemed natural that when she was 18 and enrolled in the University of Wyoming, she would choose nursing as her major. Then the doubts set in.

Her family told her she was too bright, too promising for nursing. She couldn't imagine herself changing bedpans and following orders from a doctor. She changed her major to premed, graduated with a bachelor's degree in biology in 1996 and took entrance exams before she realized she did not want to go to medical school.

Instead, she took a job as manager of a cancer surveillance program. As part of her work, she traveled the state, teaching people about cancer prevention. She was good at the research, but working with people excited her more.

"You become alive with these people," her director told her. "You need to rethink where you're going." Kaz considered pursuing a master's degree in public health. "What's wrong with going back and being a nurse?" her director asked. "You're meant for it."

Across the country, people in fields from engineering to psychology, English to computer technology, are taking another look-sometimes a first look-at a career in nursing. For some, like Kaz-now enrolled in an accelerated bachelor's degree in nursing program at the University of Northern Colorado-it's a journey back to their heart's desire.

Some say that after years of just making money, they want to do meaningful work. Others feel trapped in limited professions or have lost their jobs in a sliding economy and see new opportunities in nursing.

To attract and keep their interest, many nursing schools have established accelerated bachelor's degree programs for students who already have a degree in another field. These programs allow students to earn a BSN in 16 to 20 months, rather than completing a traditional four-year program. Some hospitals sponsor students through these programs and pay tuition in exchange for work after they graduate.

Hospital administrators say second-career nursing students make terrific nurses. They are mature, broadly educated and know how to conduct themselves in the workplace.

But the life experience that makes them great nurses also often leads them to expect more from their careers and their employers than they might as graduates fresh out of school, say health care consultants, nursing school professors and the students themselves.

The American Association of Colleges of Nursing does not have enrollment figures specifically for the accelerated programs at its member schools. But Robert Rosseter, spokesman for the association, said the number of accelerated programs has increased from 60 in 1995 to 72 last year, with 11 schools planning to add accelerated programs.

The Duke University School of Nursing in Durham, N.C., plans to offer an accelerated BSN program next year-its only baccalaureate program-as a direct response to the nursing shortage, said Mary Champagne, Ph.D., RN, FAAN, the school's dean. So far, the school has had 200 inquiries about the program, she said.

"Young people today go into college and many of them take liberal arts or basic science courses. They're not committed to a career, and until recently, nursing hasn't been an option for them," Champagne said. "This is a real, untapped pool that we might bring into nursing and help ease the severe nursing shortage that this country is going to face."

Perceptions change
Champagne is referring to people such as Holly Cousins, who works as a secretary for Nursing Student Services at South Dakota State University. Cousins said she has always been interested in health care, but never considered nursing until she began working at the university.

"One concern was going in and having doctors order me around and I'm too much of an independent person to like that very much," Champagne said.

Cousins has a degree in English. She taught for three years before deciding it wasn't for her. She admires the skill and dedication of nurses she has met in her present job. Her original perception of nursing has changed, and she plans to apply for the new accelerated program that the SDSU College of Nursing plans to offer next year.

"You kind of grow up and realize that things change in life," she said. "Nursing just fits into my life right now."

Most students in accelerated programs have degrees in psychology or biology, say nursing school deans and accelerated program directors. But they also report enrolling students with degrees in English, theater, music, art, engineering, business, marketing, philosophy and sociology.

Many say they've always wanted to be nurses but were dissuaded by family members or their own belief that nursing somehow wasn't "good enough," said nursing school deans and directors of accelerated programs.

Others say they want to go into nursing because they feel dissatisfied with their careers. One student in the accelerated program at the Research College of Nursing in Kansas City, Mo., is an accountant in his 30s who discovered he was much happier volunteering at a local children's hospital, said Nancy DeBasio, Ph.D., RN, the school's dean.

He sees nursing as a profession that not only gives him the satisfaction of helping people, but also has more variety and opportunities for growth than his old job, she said.

As the economy changes and workers in other fields are laid off, and as the image of nursing changes, nursing school and hospital administrators believe the field will attract more people. Recruiters for nursing schools are going to job fairs for retrenched tech workers, talking with personnel departments of troubled telecommunications companies and thinking of ways to approach the airline industry to see if laid-off flight attendants would consider a nursing career.

Deans at many nursing schools with accelerated programs report increased enrollments, often at rates higher than for traditional programs. The Research College of Nursing expects enrollment in the accelerated program to double from 30 students to about 60 in 2002, DeBasio said. The 11-year-old accelerated program at the University of Wisconsin-Milwaukee School of Nursing doubled its enrollment in September, from 24 to 48 students.

Second-career nursing students say they like accelerated programs because they don't have to revisit the university scene they left behind and they can enter the workforce quickly. In addition to a long list of prerequisite courses, mostly human sciences and psychology, most programs last three semesters and require 18 to 20 hours of coursework and another three to five hours of clinicals per week.

"You have to be absolutely committed," said Geralyn Meyer, Ph.D., RN, coordinator of the accelerated option at Saint Louis University School of Nursing, the oldest accelerated nursing program in the country. "But if they can do it in a year, they know they'll be out there doing what they want to do, and that makes the program attractive."

When the school began its program in 1971, some hospital nurses and administrators questioned whether schools could turn out good nurses in a year, Meyer said. Now, hospitals across the country are clamoring for graduates from accelerated programs.

In some places, such as Creighton University School of Nursing in Omaha, Neb., health care organizations pay tuition for some accelerated students, who often are not eligible for government financial aid because they already have a degree. In exchange for tuition, students agree to work for the hospital after they graduate.

Poudre Valley Hospital in Fort Collins, Colo., sponsors the accelerated program at the University of Northern Colorado. The hospital pays faculty from the university, as well as full tuition for the nine students in the program. Poudre Valley, a magnet hospital known for its commitment to nurses, had already offered scholarships to the university's four-year program, said Margo Karsten, MSN, RN, chief operating officer at the hospital.

"We were trying to think creatively about how to throw the net out a little farther and get people interested in nursing," she said. In exchange for fees and tuition, the students have contracted to work for four years at the hospital after graduation.

'They catch on quickly'
Unlike many traditional students fresh out of high school, second-career students have good study habits and are more interested in earning their degrees than in hanging out with friends and learning the ropes of campus life, deans and instructors say.

"They catch on quickly," said Sister Carol Purzycki, Ph.D., RN, coordinator of the accelerated BSN program at Mount St. Mary's College in Los Angeles. "They're very motivated. They're adult learners."

Many have researched the field and have talked to or shadowed nurses, said Connie Miller, MSN, RN, chair of the accelerated program at Creighton.

Although about 80 percent of the students in the University of Wisconsin-Milwaukee accelerated nursing program work in hospitals after they graduate, most plan to continue their education and go into a specific field of nursing such as family nurse practitioner or community health, said Susan Dean-Baar, Ph.D., RN, FAAN, associate dean of the school of nursing.

Tracy Hulbert, 31, a student in the UW-Milwaukee accelerated program, has traveled around the world, worked four years as a consultant in Japan, speaks Spanish and Japanese and has bachelor's degrees in Spanish and psychology. After earning her BSN, she plans to pursue a dual master's degree in public health and family nurse practitioner.

Her dream, she said, is to work in the World Health Organization, perhaps with developing countries in Southeast Asia.

Professors and administrators do not usually intimidate second-career students, who tend to see them as peers. For example, Dean-Baar said her nursing students meet twice a year with the president of a large local health care system that works with the school. In the spring, he meets with traditional four-year students; in the fall with the accelerated group.

The traditional students have little to say and the president does most of the talking, she said.

But the accelerated students ask about everything from what the health care system is doing for nurses, to how it serves the community, to the inner workings of its finances.

Perhaps because of their study habits, maturity and commitment, second-career students usually pass the boards without much trouble, deans and instructors say. Some accelerated classes report regular 100 percent pass rates, while others are consistently in the high 90s.

Professional, responsible
The same qualities that make them excellent students, plus their work experience, make many second-career graduates favorites with hospital supervisors and co-workers.

"I find that the accelerated students are much more professional, responsible individuals," said Shelly Spencer, MSN, RN, nurse manager of trauma and general surgery at Saint Louis University Hospital. "You find that they are more mature in looking at patient care and patient needs. They are outcome-focused. Their accountability is much greater than that of traditional students."

Spencer hired four graduates of the university's accelerated program last year. One graduate, who previously worked in business and management, already has worked as a charge nurse many times, Spencer said. Her business experience has helped her organize and delegate responsibilities to peers and nursing assistants.

Because they know what's out there, second-career nurses often expect something back from their employers, Meyer said.

"These are individuals who are going to ask the tough economic questions," Dean-Baar said. "They're going to want to be paid for what they're worth."

Many second-career nurses do not see their careers ending in the hospital at the bedside, said Tim Porter-O'Grady, Ph.D., RN, FAAN, a professor at Emory University in Atlanta and the head of Tim Porter-O'Grady Associates Inc., a consulting firm that works with health care organizations in crisis.

They want to go to graduate school, work as nurse practitioners or nurse midwives, become nurse anesthetists, go into public health or community education.

Hospitals that want to attract and keep top second-career students need to offer good pay and benefits, flexible schedules, autonomy and respect for nurses and strong leadership, he said. They need to show they are committed to patient care. They need to have a reputation for recognizing what nurses do and what they need to do it.

In return, he said, health care organizations can expect more from these nurses and trust their decisions. Instead of becoming frustrated by problems in health care and leaving the field, "they're more likely to stay and change things," Porter-O'Grady said.

Realizing their dream
Even mid-career nurses who set out to work at the bedside may find themselves swept into roles they'd never imagined.

John Shier, RN, a graduate of the University of Wisconsin-Milwaukee accelerated program, chose nursing as a third career, after caring for a dying friend.

He has a doctorate in philosophy and taught at the University of Wisconsin-Madison for 14 years, then served as an executive for two large nonprofit organizations for 18 years.

After graduating from the nursing program in the mid-1990s, he worked as a hospice nurse and on a cardiac unit at Bellin Health in Green Bay, Wis. Seeing so many advanced cases of heart disease made him wonder what he could do to get people to take care of themselves before it was too late.

Using his philosophy, teaching, business and nursing experience, he developed a program called "Live Long and Die Healthy" that is used by corporations and two nationwide trucking firms. He promotes healthful lifestyles as coordinator of the hospital's corporate health and wellness program. And he continues his hospice work. "That's why I went into nursing," he said.

As for Kaz, her images of bedpans are long gone. "I didn't realize the scope of nursing, how many things you can do with a nursing degree," she said.

But for now, she can't wait to do the work she believes she was born to do. "I just want to be with the people, the kids, the babies," she said. "I like the fact that I'm going to be a staff nurse and finally realize my dream."

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New wave of nursing students?

A number of nursing schools around the country report increased enrollments in both traditional and accelerated baccalaureate programs. Although complete data won't be available until January, the American Association of Colleges of Nursing expects to see a reversal of a six-year trend of declining enrollments, said Robert Rosseter, director of public affairs for the association.

Nursing schools in Texas, Virginia, Maryland, Hawaii, Idaho and Ohio are among those reporting enrollment increases. Schools polled by the Texas Nurses Association showed an enrollment increase of 13 percent to 14 percent, according to an article in the Houston Chronicle. "The reasons for this expected increase are many," Rosseter said. "Schools have stepped up marketing efforts in response to the nursing shortage and have launched image campaigns that educate potential students about all the opportunities that exist in nursing."

Rosseter also credited partnerships between schools and health care facilities and media attention to the nursing shortage, with reports of signing bonuses, scholarships and other benefits for new nurses.

A number of nursing school deans said they thought the changing economy has made more people consider nursing because so many jobs are available and will be for a while because of a nursing shortage that is expected to increase, as many nurses retire.

"I think the word is out that there's a career in nursing, that there are jobs in nursing," said Noreen Frisch, Ph.D., RN, professor and chair of the department of nursing at Cleveland State University, one of the schools reporting increased enrollment. Frisch reported an "overwhelming" response among students applying to the university's new accelerated BSN program, as well as enrollment increases in traditional and RN-to-BSN programs.

Some believe that a changing social-as well as economic-climate is attracting more people to service careers such as nursing. "What usually happens after an event like Sept. 11 is that the next academic year there's a slight increase in applications to more humanistic fields," said Tim Porter-O'Grady, Ph.D., RN, FAAN, a professor at Emory University in Atlanta and the head of Tim Porter-O'Grady Associates Inc., a consulting firm that works with health care organizations in crisis. "It causes people to have a re-examination of their lives."

Some nursing school deans and hospital administrators say they are concerned about a possible increase in students who seem interested in nursing only because they want a guaranteed job. On the other hand, they say, nursing is such a demanding career and the programs so intense that the selection happens naturally.

Marilyn Cahalane, RN, a nurse recruiter for Saint Joseph Hospital in Omaha, Neb., said she doesn't see anything wrong with people going into nursing because they want financial stability. That is part of the job's attraction, she said. "This work is very hard, but very rewarding," she said, "and if you don't feel that within yourself, you will get out of nursing."

At this point, Rosseter said, no one can estimate the size of the expected enrollment increase or whether it will have a significant affect on the nursing shortage in years to come. "An increase in enrollment is a step in the right direction," he said.

But many believe it may be too little, too late.

About half the nurses in the country will reach retirement age in the next 10 years as about 78 million aging baby boomers are expected to enter the health care system, said Nancy DeBasio, Ph.D., RN, dean of the Research College of Nursing in Kansas City, Mo. "I don't think we'll ever see an enrollment increase that's going to address that," she said.
Cathryn Domrose

For more information on nursing schools that offer accelerated bachelor's degree programs, contact your state board of nursing or the American Association of Colleges of Nursing at (202) 463-6930, www.aacn.nche.edu/.