Nursing Schools Need to Reconsider Their Admission Policies
July 19, 2011 -- I appreciate your no-holds approach to the problems in our healthcare system, and applaud your recent coverage of the nursing shortage.
Your article mentioned the looming retirement of our nursing workforce, and the problems retaining quality nursing instructors. I was disappointed that the process to get into nursing school wasn't given more coverage.
I recently stepped away from my plans to add an RN to my MPH due to multiple barriers that are present in the application process for nursing school. Until recently, I’ve been completing prerequisites and working on applications to OHSU, Linfield, University of Portland, Mt. Hood, PCC, Clark College and Clackamas College. It is very frustrating to keep hearing about the RN shortage while being denied the ability to apply for RN school. I have at least three other colleagues in public health who will not be applying to nursing school for similar reasons… two of these colleagues have advanced degrees and are fantastic leaders and would be great nurses.
RN Schools Give Preference to the Inexperienced
In addition to there being way more applicants for nursing programs than open spots (the acceptance rate is around 10 percent of qualified applicants), there’s also a strong bias towards 1st-degree, younger, less experienced applicants for nursing schools. This bias does not bode well for the future of leaders in nursing over the next decade.
The criteria for being accepted hinges more on your application G.P.A. than on any other aspect of an applicant's potential for nursing. For instance, one program takes into account your cumulative G.P.A. of all college courses for life (which for me covers approximately 15 years of classes in a variety of subjects in five different universities). The application process does not accept letters of recommendation, work history or resumes. This means the ‘D’ in theater appreciation I got at age 17 counts more than my seven years in healthcare, my certificate of management, or my Masters in Public Health!
Furthermore, there are no part-time RN programs in Oregon (unlike in many other states). Mount Hood College had a single class accepted into their part-time program before it was shut down due to budget issues. This lack of part-time or evening options effectively removes many of us from the application pool since we have mortgage payments, full-time jobs, and family duties that prevent us from going to school from 8-5 (plus time for clinical rotations on weekends).
At this point the only people who can apply are either without these life obligations or are able to do school full time and not work longer than 20 hours per week, or those who can manage to work nights and go to school all day. I posit that earning a ‘B’ in anatomy while working full-time in a demanding professional job, and holding down a mortgage while raising children should be the equivalent to earning an ‘A’ in anatomy while living in your parents’ house and working as a barista.
Is there even any evidence that getting an ‘A’ versus a ‘B’ has any relevance on how good of a nurse you will become? While the RN shortage will create increased need for leaders with strong backgrounds and life experiences, the application process give heavy preference to young applicants with little or no experiences to draw upon. This adds to the 'brain drain' and may decrease the ability of our RN workforce to handle the increasingly complex world of healthcare... a field that has long-since moved away from the original role of nurses changing bedpans and acting as the ‘doctor’s helper.’
RN Schools Have no Standard Set of Prerequisites
A large barrier to entry is the wide the variety of requirements to apply. Of course each school has the usual: 1 year of anatomy and physiology, 1 term of microbiology, classes in human development, psychology, nutrition, math and reading. There is still a wide variety of how those credits are considered.
Despite many Oregon RN schools being part of the OCNE curriculum (which tries to standardize the RN application process in Oregon), each school has slightly different general education requirements to apply so students applying to more than a few RN schools are stuck taking a crazy mixture of pre-requisites, thus taking longer to complete and incurring more out-of-pocket costs. Of the schools I was considering: One school wants two additional social science classes and an American history (political science or world history does not count). Another wants an additional year of lab sciences, above the 1.5 years of anatomy and microbiology. One school wants math 95 or statistics 243, but does not count biostatistics 524… while the others do. To make it even more complicated, each school has a different timeline for how long credits will last before they expire.
Despite having a Masters in a health-related field, and a Bachelors in a social-science, and a Graduate Certificate in Management, I found myself taking a list of 100-level courses that are not remotely related to the field of nursing… only for the privilege of hedging my bets and paying application fees to multiple schools in hopes of being accepted by at least one of them.
RN Schools Should Turn Leaders Into Nurses
As it is now, the hope for replacing our quickly-retiring nurses and clinical instructors hinges on a bet that at least some of the new nursing graduates will fill in that gap. This means that we will be dependent on newer nurses taking over leadership roles that are better filled by nurses who have more experience. It also means that those newer nurses will be asked to accept the lower pay and, generally, less exciting roles of nurse educator and nurse administrator.
I find these assumptions to lack a solid foundation. It is more likely that newer nurses will desire the higher wages and more exciting roles of clinical settings and the shortage will be felt even more strongly in the nurse leadership roles than it is already. This self-repeating cycle will continue until the career of nursing will be demeaned by a lack of strong leaders, educators, and mentors and a burgeoning bottom-heavy group of inexperienced nurses will struggle to keep up with the changing definitions of their career. As the shortage grows, nurse leaders that remain in their posts will be overburdened, dragged down, and eventually tempted to join the ranks of the clinical providers rather than remain in the fight.
A potential solution to this dilemma is to attract and recruit persons who are already leaders in their careers (be it health care or not) and incentivize them to becoming nurses by making their experience count in the application process. I suggest creation of an application process that gives consideration for an applicant’s current leadership roles, or somehow accounts for other indicators of being a successful nurse.
This solution would not only leave room for our many new nursing graduates in some of the more clinically-focused areas, but would stock the leadership circles in nursing with persons who bring a wealth of experience and connections with them.
Bryan earned his Masters of Public Health with focus in health policy and non-profit management from Portland State University. He works as a program coordinator for the Oregon Health Authority and worked as an EMT in New Mexico for several years.