The Institute of Medicine’s [1
] Future of Nursing: Leading Change, Advancing Health outlines eight recommendations to improve health care
in the United States (U.S.) via nursing changes. Recommendations for nursing address the need to increase the U.S. proportion of nurses with baccalaureate degree to 80 percent by 2020. The IOM report elaborates on the need to decrease barriers by defining academic pathways that promote seamless progression and access for nurses to higher levels of education; promotion and support (financial) by health care agencies; salary differential for employed nurses with higher degrees; expanding baccalaureate programs through increased funding, scholarships and loan programs; early and continuous intra-professional collaboration with other disciplines; and recruitment of diverse student populations [1
]. The Carnegie Foundation for the Advancement of Teaching: Preparation for the Professions report Educating Nurses: A Call for Radical Transformation recommends an immediate need to streamline nursing
education between community colleges and baccalaureate programs, “to allow for early completion of a baccalaureate program that are feasible, fair, and affordable for all nursing students” [2
]. Health care practice requires increasing the quantity and quality of registered nurses to the baccalaureate level to address part of the critical nurse shortage problem and need for highly qualified professionals [1
Experts on U.S. workforce issues predict a major shortage of nurses of up to million by 2020, related to the following factors: increased numbers of newly insured under the Affordable Health Care Act; increased numbers in the population; increased numbers of older individuals; an aging of the nursing workforce; and expanded areas of health care service [3
]. The shortage is based on a supply-demand model that indicates a growing demand for nurses related to an increased general population, increase in those older than 65 years of age, and increase in the number of people gaining access to health care as a result of the Affordable Care Act [4
]. The supply of nurses remains a challenge due to a high portion of nurses approaching retirement age and limitations on enrollment rate in schools of nursing due to the faculty shortage and clinical placements [5
]. The current U.S. percentage of nurses prepared at the Associate Degree (ADN) level is 45.5% and Baccalaureate degree (BS/BSN) level is 33.7% [4
The Institute of Medicine’s report [1
] states health care will need more nurses to address the predicted shortage. Additionally, these nurses should have higher levels of preparation to address improved patient outcomes. Evidence supports the IOM recommendation, indicating nurses with baccalaureate degrees are linked to lower rates of mortality [6
]; are better prepared to provide safe and effective care than associate degree nurses [8
]; and demonstrate better communication skills, knowledge, problem solving, patient-teaching and psychosocial skills [9
]. More nurses will be needed with advanced education and skill to meet the demands of the future [1
]. Meeting this need will require streamlining programs to produce increase the number nurses prepared at the baccalaureate, or higher level of education.
The U.S. Tri-Council for nursing [10
] endorsed a position statement on the need to enhance the educational advancement of registered nurses. In response, many academic nursing programs continued to develop articulation partnerships spelling out the necessary coursework for degree transition
from community college to baccalaureate education. Presently, students still find many challenges that influence their decision to pursue and attain advanced education. Researchers have explored personal characteristics, work attributes and work attitudes to predict if a nurse with an associate or bachelor’s degree would enroll or complete a higher educational level [11
], finding predictors of obtaining the BSN degree include: being black, living in a rural area, non-nursing work experience, higher work motivation, working in the intensive care units and working day shifts.
There is limited current data on barriers and enhancing factors related to transition from the associate to baccalaureate nursing degrees offered through Registered Nurse to Baccalaureate (RN-BS/BSN) programs, although there is rich anecdotal data. Students report complicated admissions requirements, including pre-requisite nursing courses and liberal arts and sciences classes that vary from one institution to another; financial barriers; conflicting responsibilities of work or family; and lack of guidance [12
]. Only two older qualitative studies [13
] explored the transition issues, revealing several barrier themes, including: a variation of expectations, tentative beginnings, limited time, lack of confidence/fear, insufficient recognition for past educational and life experiences, insufficient differentiation in roles of different registered nurses (RNs) prepared at different educational levels, and lack of basic academic support. Students in these studies identified several factors (enhancement/motivational) that facilitated advancing their education, including: it was the right time and place in life to go to school, looking forward/continuing job opportunities, achieving a personal goal, and obtaining support and encouragement to return to school identification of cornerstone courses that led to significant change [13
]. Nurse educators and clinical leaders have actively pursued measures to ease the transition in RN-BSN programs, including articulation models, joint enrollment projects, cohort admission programs with clinical agencies and various other measures. However, most of the measures are relatively new and have not been analyzed for impact. In order to best understand the issue and develop solutions, the current study explored students’ perceptions of barriers and enhancement factors in academic transition in this decade.