Online Cure for the Nursing Crisis

With the baby boom generation wading into retirement, America needs more nurses. Many current nurses need more education. And, increasingly, it appears online degree programs are going to play a critical role in providing it.

A report released last month from the Carnegie Foundation for the Advancement of Teaching asserting that all working nurses should be required to hold a bachelor’s degree in the field prompted several retorts from the nursing world. Beverly Malone, CEO of the New York-based National League for Nursing, wrote that additional credentialing is valuable but should not be a legal requirement. Kim Tinsley, a board member at the National Organization of Associate Degree Nursing, argued that such a mandate would place an undue burden on aspiring nurses who couldn’t afford to feed their families if they had to attend school for two extra years.

While the Carnegie recommendation is controversial, the number of registered nurses seeking advanced training is likely to rise. There is legislation pending in 18 states that would order nurses who hold only associate degrees return to school for a Bachelor of Science degree in nursing within 10 years of graduating from their associate’s program. The American Association of Colleges of Nursing has been advocating for the legislation, in large part because one of the key aspects of the nursing shortage is a dearth of qualified faculty, and nurses who hold bachelor’s are four times as likely to then pursue master’s degrees and possibly turn to teaching.

So demand for bachelor’s programs in nursing stands to rise — more specifically, demand for programs that allow students the flexibility to continue their nursing education without leaving work. “Online is increasingly the option for the student who does not have the ability to get on campus for a traditional course and who needs to balance home, work, and school,” says Linda L. Strong, coordinator of the R.N. to B.S.N program at Sacred Heart University.

Rising demand, of course, means not only more students to educate, but an expansion of the market and more money to be made. “The pie is very much still growing,” says Gerry Digiusto, a senior analyst at the higher-ed consulting firm Eduventures. And while forays into the potentially lucrative online education market can sometimes backfire, creating an online nursing degree program is a relatively low-risk venture. “Online programs have done their best in career oriented fields,” Digiusto says. “And healthcare programs have had great success online.”

As a result, nonprofit colleges have not been shy about vying for pieces of the pie, competing hard with the deep-pocketed for-profit institutions that typically dominate the online market.

This is not a new phenomenon; colleges have been moving their nursing programs online for almost as long as online education has existed. But they are doing so now at a fast rate: The number of fully online R.N. to B.S.N. programs in America has grown by more than a third in the last two years according to the American Association of Colleges of Nursing — from 96 in 2007, when the association first started collecting data on online program, to 129 in 2009. (This still represents a mere fraction of the 621 R.N. to B.S.N. programs that exist nationwide.)

Colleges that already have established nursing programs are particularly well-positioned to carve out pieces of the market, since they already have personnel and a curricular infrastructure in place, Digiusto says. They also have ties to graduates from their associate’s degree tracks who may soon need to come back for a bachelor’s.

Such is the case in New York, where, as the so-called “B.S.N. in 10” legislation looks to have good support in the state assembly and the senate, a handful of State University of New York (SUNY) campuses have created — or are preparing to create — online versions of their R.N. to B.S.N. programs.

“There are many, many graduates to tap within the state system,” says Mary Pat Lewis, chair of the nursing school at SUNY-Delhi. Delhi, she says, polled graduates of its own associate’s degree program and found “overwhelmingly” that they would enroll in an online B.S.N. program with their alma mater if the price was right.

So Delhi made it relatively inexpensive: $207 per credit hour (60 credit hours are typically required), lower than at least two of its for-profit competitors — Walden University, which rolled out its program last March, charges $255 per credit hour, and University of Phoenix charges $450 per credit hour for its fully online program. Delhi also chose not to charge differently for in-state and out-of-state students, and shortened the program to 12 months from the typical 18 in order to let more students matriculate. It currently enrolls 250 students from all over the country in the program, and claims to be profitable, with plans to expand.

“It’s certainly an important part of our revenue growth strategy,” said Joel Smith, a campus spokesperson.

Although nursing degrees require clinical training, it is possible to run fully online R.N. to B.S.N. programs because they accept transfer credits from registered nurses who have already logged the requisite clinic hours and only need to complete an academic curriculum to earn a bachelor’s. Still, there are nearly as many "hybrid" R.N. to B.S.N. programs (50 to 99 percent online) in the country, 114, as fully online ones. The important difference is that fully online programs can compete for students all over the country, not their in own regions.

The University of Phoenix, which enrolls 6,675 students in its R.N. to B.S.N. program, says it does not feel at all threatened by its new nonprofit competitors. Supply is so out of proportion with demand that everyone stands to grow, says Angie Strawn, associate dean of the university’s nursing school. “Given the high demand for qualified nurses and the limited number of spots available to incoming nursing students,” she says, “we… view them as partners rather than competitors.”


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