Addressing the Nursing Shortage

The number of registered nurses who earned bachelor's degrees in nursing increased by 170 percent since 2010 because of the rapid expansion of online RN-to-BSN programs, according to the American Association of Colleges of Nursing.

RNs have associate degrees, while BSNs graduated from four-year bachelor of science programs. Because many RNs are working full time, online programs offer a welcome, viable option for academic progression, said Linda Washington, associate dean of Broward College’s RN-to-BSN program. “It’s needed in today’s world,” she said. 

The steady rise in online as well as face-to-face nursing programs comes on the heels of a 2010 recommendation from the Institute of Medicine that at least 80 percent of nurses hold baccalaureate degrees by 2020. In total, the number of RNs who earned BSN degrees increased by more than 600 percent since 2003, the first year the nursing association collected data. 

Many RNs, colleges and employers have taken that recommendation to heart. In 2011, only 30 percent of employers required newly hired RNs to have BSNs. In 2016, that number was 54 percent, according to an AACN survey. Today, about 98 percent of employers prefer to hire BSN nurses, said the association, which represents baccalaureate and graduate nursing programs and students.

Since the recommendation from IOM -- which is now the Health and Medicine Division of the National Academy of Sciences -- a private organization that weighs in on national health matters, more than 100 new college BSN programs have cropped up across the country, and enrollment numbers are steadily rising, said Robert Rosseter, an AACN spokesperson.

Simultaneously, colleges that already offered RN-to-BSN programs are enrolling almost 80 percent more students than they did seven years ago. The numbers rose from about 77,000 in 2011 to 137,000 now, the association said.

Hands-on to Online

The vast majority of associate degree nursing programs that lead to RN jobs still conduct hands-on training and coursework face to face. Although there are some opportunities for hybrid courses and technology inclusion, pre-licensure programs are heavy on clinical work, such as administering injections, which is difficult to replicate online, said Donna Meyer, CEO of the Organization for Associate Degree Nursing.

But for post-licensure BSN nursing programs, which often focus on leadership, safety, quality of care and communication, the transition to online education has been relatively smooth, said Juliann Sebastian, dean of the University of Nebraska Medical Center’s College of Nursing. Asynchronous online courses allow many working nurses, including those with families, to earn BSNs and graduate degrees at their own pace, she said.  

“Online has absolutely offered us some opportunities to expand the numbers of nurses at baccalaureate or higher degrees,” said Sebastian, who is chair of the AACN board. “The flexibility that asynchronous online courses offer has some real advantages.”

In addition, online degree programs are vital to RNs working in small communities or remote areas, Meyer said. For example, there’s only one university in Wyoming that offers a bachelor degree in nursing. In southern Illinois, there are none.

In 2016, more than 50 percent of RN-to-BSN programs were offered completely online, and all but a handful of the rest offered significant online coursework, according to the AACN. By comparison, in 2011, less than 30 percent of RN-to-BSN programs were offered entirely online and 20 percent had no online offerings.

Benefits and Challenges 

At the University of Akron, more than 75 percent of its approximately 120 nursing students are pursuing BSNs online, said Pamela Bonnett, director of the RN-to-BSN program.

For years, Bonnett taught in a traditional classroom and loved it. But after acclimating to teaching online courses and learning how to capitalize on technology, Bonnett said she found that online education is as effective as face-to-face courses -- if not more so.

“We have grown to where we can easily adapt any classroom situation to an online situation, and we can make it as productive and rich as we did in class,” she said. “There are so many features to online learning that have actually enhanced our teaching role.”

Bonnett said the expansion of online nursing programs is making getting a BSN “convenient and flexible” for licensed and practicing nurses. Last year Akron changed its RN-to-BSN program to include multiple start dates throughout the year, and in response, the university already has seen a 50-percent increase in enrollment.

At Broward College in Florida, the fully online RN-to-BSN track represents about 40 percent of the college’s nursing student enrollment, Washington said.

Like others in her position, Washington said it became a necessity to offer online nursing courses, but that Broward didn’t want to compromise the quality of the teaching or the rigor of the coursework.

“We fully support online,” she said. “The changes must come with us in academia -- we have to make it accessible and affordable. We have to make it creative.”

Broward offers ways to supplement clinical labs using a virtual program with avatars that act as patients; students can ask the avatars questions and get responses. They also can check a patient’s nose, ears, mouth and eyes, and perform standard assessments that they might do in an in-person lab.

However, Washington admitted that the virtual clinical portion has challenges. “You probably would not see it at the same level of proficiency as those that had the hands-on [portion] face to face,” she said.

Graduate Programs Online, Too

As with RN-to-BSN programs, online graduate programs are offering convenience and flexibility to nurses who want to continue working while pursuing advanced degrees and for those who don't live near a face-to-face graduate nursing program.

Since it began offering its online graduate program in 2005, the University of Cincinnati’s College of Nursing has experienced significant enrollment growth, said Christine Colella, director of the nurse practitioner program.

“We have students from all across the country,” Colella said, adding the university attracts nurses from all 50 states and those who don’t have easy access to a program in their communities.

Although all the nursing instructors and administrators interviewed for this story said online nursing programs are a necessity, they emphasized that students must be self-disciplined and motivated to succeed.

“What the student gets out of it -- much of that hinges on the motivation of the student,” Washington said. “You are doing a bit more to make up the difference of what you’re missing in a face-to-face environment.”