Published: June 23, 2012
ABINGTON, Pa. — Jennifer Matton is going to college for the third time, no easy thing with a job, church groups and four children with activities from lacrosse to Boy Scouts. She always planned to return to school, but as it turned out, she had little choice: her career depended on it. 
Ms. Matton, a nurse, works at Abington Memorial Hospital, one of hundreds around the country that have started to require that their nurses have at least a bachelor’s degree in nursing. Many more hospitals prefer to hire those with such degrees.
That shift has contributed to a surge in enrollment in nursing courses at four-year colleges, particularly at the more than 600 schools that have opened “R.N. to B.S.N.” programs, for people who are already registered nurses to earn bachelor’s degrees. Fueled by the growth in online courses, enrollment in such programs is almost 90,000, up from fewer than 30,000 a decade ago, according to the American Association of Colleges of Nursing.
The need is so great that nurses without bachelor’s degrees are still in demand. But experts say that may change in years to come, particularly at hospitals, the largest segment of the profession and one of the best paid.
Enrollment in community college programs, the typical path to becoming a nurse, remains strong, but many of those schools are looking for new arrangements, like partnerships with four-year schools, to keep their graduates competitive.
Ms. Matton, 37, first went to college for an associate degree in radio and television broadcasting. By the time she returned to school for an associate’s in nursing, she was a wife and mother — she gave birth to her youngest a few days before taking an exam. Now she is weeks away from her third degree, a bachelor’s in nursing from Drexel University in Philadelphia, with most of the work done online.
“I wanted to get the bachelor’s at the start, but I needed to start earning some money,” said Ms. Matton, whose husband, Joel, is a computer programmer. “Now I need to do this for job security, to have opp
ortunities down the road.”
Schools like Drexel have seized the opportunity. Its online R.N. to B.S.N. program began in the late 1990s with a few dozen students and today has 650. Over all, its College of Nursing and Health Professions has doubled over the last decade, to about 2,400 students, making it one of the nation’s largest.
“There are several hospitals in our region, like Abington, that will hire nonbaccalaureate nurses but give you a certain number of years to finish the baccalaureate, and some that won’t even interview you without it,” said Gloria Donnelly, dean of the nursing college.
Such policies are limited to a small fraction of the nation’s more than 5,000 hospitals — while no definitive count exists, they tend to be teaching hospitals in major metropolitan areas — but the number is rising fast. Hospital and nursing school officials say most hospitals insisting on bachelor’s degrees began doing so in the last five years, like Abington, a suburban hospital north of Philadelphia, which adopted its policy in 2010.
Surveys show that most hospitals prefer to hire nurses with bachelor’s degrees, though they often cannot find enough. Lawmakers in several states, including New York, have introduced bills that would require at least some hospital staff nurses to have bachelor’s degrees within 10 years, though none have become law.
No matter the type of nursing school, a graduate who passes a national licensing exam becomes an R.N., and for decades, that was the only credential that mattered to hospitals. (Licensed practical nurses, or L.P.N.’s, who take a different version of the exam, can perform fewer functions and are being phased out of hospitals.)
Not long ago, most nurses did not go to college at all, but to nursing schools run by hospitals — including one still run by Abington — that do not confer degrees. As recently as the mid-1980s, half of the country’s registered nurses had started that way. But by then, hospital-based schools were closing in droves, and community college education was becoming the norm.
Still, professional groups and employers continue to push for more education, citing studies linking better-educated nurses to better patient care. Where traditional nursing education focuses on practical skills, students in four-year programs learn more about theory, public health and research.
An added incentive for hospitals is the coveted “magnet” designation, awarded by the American Nurses Association to about 400 hospitals and sometimes featured in their advertising. Among the association’s criteria for magnet status is the nursing staff’s level of education.
A 2008 federal government survey showed that among newly minted nurses, only 3 percent had graduated from nondegree programs, 58 percent from community colleges, and 39 percent from four-year colleges. With more of them returning to school, half of the nation’s 3 million registered nurses had a bachelor’s or master’s degree in nursing.
In 2010, the Institute of Medicine called for raising that figure to 80 percent by 2020, but that is a tall order.
“The baccalaureate programs can’t find enough qualified instructors, so they turn away tens of thousands of qualified applicants every year,” said Geraldine Bednash, chief executive of the American Association of Colleges of Nursing. “There’s going to be a big need for community-college-educated nurses for a long time, but they may be increasingly limited to nonhospital settings.”
But many community colleges are finding ways to appeal to students who want more than an associate degree. A handful of community colleges have won permission to offer bachelor’s degrees in nursing — notably Miami Dade College, one of the nation’s largest, which started its bachelor’s program in 2008 — and other schools have petitioned state regulators and accreditation agencies to do the same.
Many more junior colleges have made arrangements with four-year colleges to help nursing students move more readily from one to the other. In Oregon, eight community colleges and the state’s Health and Science University have shared a nursing curriculum since 2006, an approach since adopted by others around the country.
“I really don’t foresee a day when the nursing pipeline can continue without community colleges, but we have to take steps to ensure our graduates remain marketable, and some programs may not survive in the long run,” said Nell Ard, director of nursing at Collin College, a community college outside Dallas. Each Collin nursing student is enrolled simultaneously in one of two four-year state schools, allowing for a seamless transfer.
But a bachelor’s program sets a high a bar for many would-be nurses and working nurses, who are older than their counterparts of a generation ago and are more likely to have family obligations. It is, increasingly, a second career; the typical starting age is around 30.
“My school puts more pressure on us, no question, and more household stuff falls to the wayside,” said Ms. Matton, 37, sitting in her kitchen and eating a hamburger her husband had waiting when she got home. She shifted a few years ago to working part time.
Yet she endorses the bachelor’s requirement, pointing to the high stakes of her job, working in the emergency room. On a recent day that she described as slow, she had treated, among others, a middle-aged man who fainted in the heat and needed a cardiac work-up, a young woman in withdrawal from an opiate addiction, a pregnant woman with abdominal pain who spoke no English, an elderly woman with a badly infected thumbnail, an elderly man with gastrointestinal bleeding who had an adverse reaction to a plasma transfusion, and a young man whose tingling hands, head pain and elevated blood pressure persuaded a doctor to order a CT scan.
“It blows me away how much influence nurses have on serious treatment decisions,” Ms. Matton said. “After going back to school, I think more critically about what we’re doing, and I have a better understanding of why we’re doing it.”
