Advancing nursing education

With healthcare reform looming, Central Massachusetts nursing educators said hospitals and medical practices need highly knowledgeable nurses to fill vacated jobs and to leverage their academic prowess to help determine what the nursing profession will look like down the line.

Becker College this fall is launching a master's degree of science in nursing, where students can specialize in either global leadership or nursing informatics to assume leadership positions in health care – as a charge nurse, a nursing supervisor or an educator, for example.

This makes Becker the latest college in Central Massachusetts to offer a program for nurses to obtain advanced degrees; the University of Massachusetts Medical School has a revered graduate nursing program and so does Worcester State University.

As nurses continue to take on higher-level roles in the healthcare field, the push is on for them to seek master's degrees or even a Ph.D., according to the American Association of Colleges of Nursing and several local nursing educators. In 2012, a nursing workforce plan released by the Massachusetts Department of Higher Education set a goal of raising the percentage of registered nurses with a bachelor's degree or above from 55 percent to 66 percent by 2020, inspired by a 2010 report from the national nonprofit Institute of Medicine recommending 80 percent of registered nurses get a bachelor's or higher by that same year.

At UMass Medical School's Graduate School of Nursing, all nurses are now required to pursue a doctorate: either a research-based Ph.D. or a doctor of nursing practice.

“We wanted to raise the standard of practice, because we believe when we raise the standard of practice, we raise the standard of care. People will look at a patient more holistically with that evidence,” said Joan Vitello, dean of the UMass nursing school. “It really encourages lifelong learning, getting that doctorate degree.”

Workforce pipeline

Between 2014 and 2024, the field for registered nurses is projected to grow by 16 percent – much faster than average growth – and the U.S. will need more than 400,000 new nurses, according to the U.S. Bureau of Labor Statistics. According to BLS, employment is projected to grow due to growing rates of chronic conditions like diabetes and obesity, an increased emphasis on preventative care, and growing demand for health care among aging Baby Boomers.

Though there is a push for nurses to pursue a master's degree or even a doctoral degree, the typical registered nurse has a bachelor's degree, according to the BLS. That's the current industry standard, said Dorothy McCabe, director of nursing and health and safety at the Massachusetts Nurses Association.

McCabe said her group encourages its members to move in that direction. To meet this need, the nurses association created four different reduced-tuition partnerships with four different schools, including Becker. Massachusetts Nurses Association members admitted to Becker for either their bachelor's degree or master's degree get 15 percent off their tuition, McCabe said.

“Our goal is simple: Every nurse should have a bachelor of science degree in nursing. But that has become the industry standard also,” she said. “Nurses working with associate's degree, for example, at Quinsigamond [Community College in Worcester], unfortunately hospitals are not hiring them. QCC does have plans, they do encourage their graduates to go to Worcester State or Becker.”

Several factors have affected supply and demand when it comes to nurses, according to the Massachusetts Department of Higher Education's Nursing and Allied Health Initiative. Nurses who planned to retire around the economic downturn instead stayed in their jobs, some went back to work after a spouse lost his or her job, and part-time nurses are seeking more hours. However, these are just interruptions to the bigger problem of a long-term nursing shortage.

With a shortage looming, it's not realistic to expect that every entry-level nurse is going to have a bachelor's degree, said Jane June, dean of healthcare at Quinsigamond Community College.

Nor should it be the norm, June said, because there are a lot of potentially great nurses out there whose lifestyles can't support the baccalaureate degree path and would benefit from a more upward mobility-type approach.

“If we did not exist, the students we have at Quinsigamond would never realize a dream, because they can't go for four years,” said June, who is also a commissioner for the national Accreditation Commission for Education in Nursing. “So if you allow students to step into the field, whatever their life dictates – get certified, get a job and move upwardly into a bachelor's – that should all be available for students. When the shortage hits, baccalaureate programs can't fill that void.”

QCC offers several pathways to nursing including a practical nursing program that leads to a certificate; an associate degree; an accelerated nursing associate degree for people who already hold a bachelor's degree; and an associate degree in nursing for paramedics. QCC added 50 new practical nursing seats last year and maintains training partnerships with local companies, like Worcester-based Century Homecare.

For students interested in a bachelor's degree, QCC, with Worcester State, offers a 3+1 degree, where students can complete their first three years of nursing school at Quinsigamond and finish off at Worcester State.

Programs like this one are what the state calls “RN to BSN programs” and are one of the ways the state wants to encourage nurses to go for their baccalaureate, according to a 2014 report from the Massachusetts Action Coalition.

“Community colleges service people who need to go a different route. I am very passionate about entry level for registered nurses remaining at the associate degree. We all took the same NCLEX [exam] – the success rates are very similar,” June said. “The education that students receive at the associate level is very good and allows them to practice as registered nurses, but as we move towards more technology, upward mobility is what we should be shooting for.”

Big picture

The Becker degree was developed with advancing the nursing workforce in mind, said Judith Pare, Becker's dean of nursing and health sciences. It came out of a push from the American Nurses Association and the American Association of Colleges of Nursing to offer new programs that would encourage experienced providers to get higher degrees, Pare said.

The program offers different pathways for admission – either through an associate, bachelor's or master's track – and a mostly remote curriculum, where students only have to come to campus during the first and eighth week of class and can complete the rest of the coursework online.

Becker offers concentrations in either global leadership or nursing informatics. Global leadership graduates could, in theory, go on to work for organizations like the Centers for Disease Control and Prevention or the Institute for Healthcare Improvement, or in governmental public health. Nursing informatics graduates will be able to align technology with care in health settings, in support of researchers, and in conjunction with information-technology and course development, Pare said.

“Health care is in a state of constant change. In response, the expectation is that nurses will transform their practice to coincide with those changes,” she said. “We have gone from traditional ways of care to using technology to support the needs of vulnerable populations, resulting in the need for practitioners who have the skills to manage care and to prepare younger nurses to advance their own careers.”

Informatics is incredibly important in nursing, said McCabe from the nurses association. It's not a new field, but it is one that continues to grow, according to a 2014 study from the Healthcare Information and Management Systems Society. In nursing, so much emphasis is put on following orders or sticking to a routine, without too much questioning into why the system is the way it is. But having nurses trained in informatics could help improve the way care is given, McCabe said.

“Informatics is used every day in nursing, because all the patient records are computerized. But there is an incredible need for doing research at the bedside also,” McCabe said. “The important piece of that is, 'What are the outcomes of your care? What other approach could you take that would be different to help that wound heal faster, or get that person ambulating faster?'”

Established excellence

UMass Medical School's hallmark is nurse practitioners, advanced nurses who need to have a master's degree, and a doctorate if they go to UMass. Many patients see nurse practitioners in place of a primary care physician, and tapping into the nurse practitioner population has been widely cited as one of the ways to deal with an impending shortage of primary care doctors.

Vitello said she was disappointed when a bill that would have allowed nurse practitioners in Massachusetts to practice independently without physician supervision didn't make it through the state legislature before formal sessions ended last month. Allowing nurse practitioners to work without supervision could have meant more widespread medical services in rural areas, she said.

“I was heartbroken, because I really think this could be the answer to patients getting the health care they deserve,” she said. “This is America. People shouldn't wait months to get health care.”