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Viewpoint: What today’s bumper crop of new nurses means for nursing education, healthcare employers, and consumers


Editor’s note: This issue of American Nurse Today…Online introduces a new regular department called “Viewpoint,” which highlights the thoughts, opinions, and expertise of well-known nurse leaders. We welcome your comments about these thought-provoking articles.

The combination of the rich supply of new nurse graduates and the Magnet Recognition® Program for excellence, which brings quality and economic value to healthcare organizations, is driving the expectation that new nurses should have bachelor-of-science (BSN) degrees to enter practice. For years, we’ve heard much talk of a nursing shortage. Yet, hard as it is to imagine, today we have a bubble of too many nurses. Many regional markets suddenly are swimming in a sea of new nurses, with unexpectedly large pools of bright, enthusiastic, newly minted graduates desperate for a job. Why did this happen? How long will it last?

Is health care recession proof?
By December 2010, the current economic recession in the United States will have lasted a full 3 years—coinciding with the largest enrollment of nursing students within the past 5 years, major job losses across all business sectors, and a decreasing census in hospitals (the largest employers of nurses). Job losses among the general population have led to service contraction in the healthcare field. The result: less business for hospitals and outpatient departments.

What’s more, uncertainty brought on by the 2010 healthcare reform law has caused many large healthcare organizations to defer program expansion until reimbursement changes become clearer. With many more people slated to receive healthcare services with lower reimbursement for providers, health care will be one of the last sectors to declare that it’s not recession-proof. Although it may grow due to an increased demand for services, far less dollars will be spent per patient as a result of the country’s economic status and healthcare reform. Pressure to reduce costs per case will rise dramatically.

How long will we see a glut of nurses?
For the next 5 years or perhaps longer, we may see fewer nurses retiring, opting instead to “age in place” out of fear that even if economic recovery is inevitable, keeping one’s job provides an economic safety net. About 25% of nurses are older than age 50; unless a large-scale turnover occurs in this group within the next 10 years, fewer positions may be available for new graduates seeking jobs in inpatient hospital settings.

How does Magnet designation fit into the picture?
Health care is a competitive business, and the nursing workforce is a key differentiator in how hospitals brand their services. The 372 hospitals that have earned the prestigious Magnet designation have seen increases in their bond ratings and a greater ability to “sell” quality and safety to the community.

The Magnet program elevates the reputation and standards of the nursing profession and, by association, raises educational expectations for the workforce. The Magnet program doesn’t specify educational levels for nurses. When applying for Magnet status, a healthcare organization must submit a plan describing how expectations are set and support is provided to nurses at all levels who seek formal education. Under the component of “structural empowerment,” the source of evidence for formal education specifies that organizations seeking Magnet status provide data that reflect the educational direction of the workforce. Organizations are expected to track nurse workforce data to substantiate that goals for improvement have been met.

The best nurse graduates seek employment in Magnet facilities because of their reputation as employers of choice for nurses. Thus, Magnet facilities and organizations seeking Magnet designation clearly have an incentive to hire BSN graduates.

The link between BSNs and better outcomes
The literature shows that nurses with additional education generally outperform those with less education. This is a compelling justification for hiring BSN graduates. A growing body of research clearly links baccalaureate-prepared nurses to lower mortality and failure-to-rescue rates. Studies published in Health Services Research in August 2008 and the Journal of Nursing Administration in May 2008 confirm the findings of previous research that linked educational level with patient outcomes.

The nursing workforce must consist of individuals with the capacity to take on the growing complexities of health care. Nurses must come to the table with technical, communication, and “customer service” skills combined with the ability and inclination to use research and seek compliance with standards. Patient-care results in such areas as falls, skin care, hospital-acquired infections, and patient satisfaction (all considered “nurse-sensitive measures”) must demonstrate improvements, thus guaranteeing reimbursement for the high-quality outcomes achieved.

Uniting in the call for advanced education
The Tri-Council organizations (American Association of Colleges of Nursing, American Nurses Association, American Organization of Nurse Executives, and National League for Nursing) are united in the view that a more highly educated nursing workforce is critical to meeting the nation’s nursing needs and delivering safe, effective patient care. The Tri-Council’s consensus position on educational advancement of registered nurses states: “Current healthcare reform initiatives call for a nursing workforce that integrates evidence-based clinical knowledge and research with effective communication and leadership skills. These competencies require increased education at all levels. At this tipping point for the nursing profession, action is needed now to put in place strategies to build a stronger nursing workforce. Without a more educated nursing workforce, the nation’s health will be further at risk.” (See

According to the Tri-Council, large number of nurses with advanced education are needed to serve as healthcare teachers, scientists, primary-care providers, specialists, and leaders. The Tri-Council urges “all nurses, regardless of entry-point into the profession, to continue their education in programs that grant baccalaureate, master’s, and doctoral degrees. A wide variety of education options exist to further the preparation of today’s nursing workforce, including degree-completion, online, accelerated, and part-time degree programs.”

What actions can employers take?
How can employers and nurses take advantage of today’s glut of new nurses to push for institutionalizing the expectation of entry-level BSNs for tomorrow’s workforce? How can the nursing profession as a whole as well as individual employers and individual nurses benefit from the large pool of new nurse graduates? Can we turn this into a win-win-win situation, for both the short term and long term?

The possibilities for resolving the entry-into-practice issue—once and for all—include:

  • setting hiring standards
  • partnering with human resource experts to communicate hiring expectations
  • aligning with nurse employees to help them attain educational levels that enable them to be more effective in their current and future roles.

Success story #1: VA
The Department of Veterans Affairs (VA) was the first system to achieve organization-wide adoption of advanced education as the key to individual nurse advancement. Thousands of VA nurses returned to school to enhance their education and skills. This surge in education, which took place a decade ago, contributed to the VA’s reinvention as a leader in healthcare worldwide.

The goal of advancing education for nurses with the upgrade of the Nurse Qualification Standards was set in the late 1990s. For 5 years before these standards were enacted, VA nurses met with union representatives, clinical partners, and leaders throughout the country to discuss the advantages of baccalaureate education for nurses. Getting to that goal was a long road, but it was worth the time and effort.

Success story #2: Main Line Health
An integrated healthcare system in the Philadelphia suburbs, Main Line Health received more than 600 applications this year from BSN-prepared nurse graduates for the 70 positions available in the nurse residency program. The few associate-degree nurses who applied and were accepted were Main Line Health employees who’d been supported by tuition reimbursement and met the hiring standards of a specified grade-point average and outstanding recommendations from faculty and nurse managers. To deal with the surge in applicants, Main Line Health developed a rigorous set of applicant screening tools and hiring steps that yielded an outstanding final pool of hires for the 1-year residency program.

Let’s act now
With time and further education, many graduates of nursing diploma schools and associate-degree programs have the potential to become excellent nurses and contribute to high-quality health care. However, the current market has yielded a bonanza of novice nurses with BSNs, and employers are sure to take advantage of this. As long as this bumper crop exists, the nursing profession has an excellent opportunity to develop collaborative models in which colleges and universities partner with nursing-diploma and associate-degree programs to develop bridge programs that enroll graduates immediately into BSN completion programs. Employers can support current staff in completing the BSN through local and online educational programs.

Health care is changing rapidly. Converging market forces have altered forecasts made more than 40 years ago about nurses’ educational requirements. We must heed the trends—and respond with actions to ensure that both the new nurses entering the workforce and veteran nurses have the education they need to meet the challenges ahead. This is the time for innovations that work for patients, students, and nursing schools.

Nancy M. Valentine is Senior Vice President and Chief Nursing Officer at Main Line Health in Bryn Mawr, Pennsylvania. She served as national Chief Nursing Officer for the U.S. Department of Veterans Affairs in Washington, D.C. when the VA adopted new nurse qualification standards.


  • If a BSN is so great, why do I see more jobs for LPN’s than RN’s out there.

  • Magnet Status is a very interesting concept, though, I see that many new nurses will be looking to further their education in order to be a candidate in a hospital. But he best learning they will have, is hands on nursing, in a facility, with nurses that have been doing it for a lifetime. Magnet Status could actually hurt the healthcare industry because with higher education, there is a push for a higher salary, which may not be worth it, if the nurses jump from place to place.

  • Higher education requirements for nurses is a laudable goal. In order for it to be practical, there must be a means in place for real-world nurses to advance while still raising families and paying bills. In the push to raise the acedemic standards to qualify for licensure, we must never lose sight of the fact that our primary purpose as nurses is to care for the sick and injured. People are not acedemic problems. Empathy and genuine caring cannot be taught in a classroom.

  • I have been a nurse in the field for the past 11 years. I have also seen new grads with a BSN think that they are above the basic nursing duties that we all should have as a bases for providing patient care. As a Clinical Instructor for Level I, III, and IV involved in a BSN program, I can promise you that the students I am involved with do not have that thought. Perhaps the Instructors need to remember what it is like to be a nusing doing instead of a nurse teaching. Just a thought.

  • Unfortunately the only bachelors level education recognized in the nursing profession is a BSN. I am, and know of others who are, BS and MS educated in other fields and bring 30 years of senior level management experience with me to a new career as an RN. In order to advance at my Magnet hospital, I will have to get yet another degree (BSN). What a waste. I’ll work somewhere that doesn’t require BSN and values what I bring to the table already.

  • I totally support BSN as a minimum for nurses. BUT they need to be trained as bedside nurses, assessment skills, the ability to perform ADLs, caring for patient needs and critical thinking are sorely lacking. Unfortunately our BSN programs do not prepare a nurse for nursing they prepare it for “I am a manager”arrogance when they need to teach fundamental nursing skills.I worked at one of the first Magnet hospitals and do not see the increase in caring, ability or compassion with BSN.

  • Atlanta nurse
    October 30, 2010 2:02 am

    While I certainly don’t think we should discount the experience and knowledge LPNs and ADNs bring to the profession (and I don’t believe anyone is doing so), more education is never a bad thing! Nurses, no matter what their educational backgound, should always be supportive of others who choose to advance themselves – it will only benefit the profession as a whole.

  • While I can appreciate the fact that healthcare today requires ongoing education, I don’t fully accept that a BSN guarantees good quality care. I have seen too many 4 year programs that pump out baby nurses expecting to step into management. They aren’t interested in holding an emesis basin, or inserting a rectal tube. Good nursing combines heart felt caring, and a repugnance for complacency. A good nurse is always seeking continuing education, but not necessarily a BSN.

  • I love these comments:) I have been with the VA for 5 yrs, (it took me 3 1/2 yrs to get my ADN with all the pre-req’s). After much debate I am working on my BSN. I am so tired of hearing how wonderful someone is because they have a BSN. I have met fantastic LPN’s, LVN’s, and ADN’s that I would trust with my life. To assume that someone does not have great critical thinking skills, does not learn or educate themselves because they dont have fancy letters after their name is such a sterotype.

  • The ADN v. BSN argument is an old one. They are good nursing schools and not so good. high GPA makes a better nurse? Hmmm no other careers that I am aware of ask for your college GPA in order to be hired. Having better outcomes for patients is a complex issue and not just about education. Staffing ratios, support for nurses, continuing education, wages, are also parts of the equation. This makes the NCLEX meaningless, obtaining a nursing license according to this article has no value.

  • older nurse too?
    October 26, 2010 5:09 pm

    Can we not weigh yearly educational requirements vs BSN? Our licensing boards require so many courses per year to maintain the license. Should we discount certfications that I may mention that particular organizations reap fees from nurses? How much do those certifications count-raise in pay, more respect of peers or maybe just maybe being allowed to publicize it on their name badge? This may be the cornerstone of unions for the non-BSN nurse I fear-

  • an older nurse
    October 26, 2010 7:58 am

    It is about time the nursing profession started to look and think about changing the requirements to employ RN’s where the most critically ill patients are who require the nurse with high critical thinking skills. Until we stand up for ourselves nothing will change. We want higher salaries? Stand up for the cause. Demand higher education and GPA’s to work in the field of nursing. We have one of the most important jobs in the nation. I am so proud to be a nurse.

  • I have been a VA nurse for 28yr and it has taken me this long to move to a Nurse III even after I have obtained a Masters in Nursing. Regardless of the Nurse Standards in the VA, there is no guarentee to move up to the next level. There is no reassurance that they will assist the nurse in helping him/her with furthering the education..most of the time one is on their own financing if they want to move on in their education.

  • While I absolutely agree that everyone in nursing should strive for further education, I believe that it needs to start at the beginning of their college careers. I just graduated in May from a rigorous 3 year ASN program. If I wanted my BSN right now, I would have to take an additional 2 years through my college. How is it that any other bachelor degree requires 4 years, and for the nurses in my area we can’t have a BSN with less than 5?

  • The Nurses Nurse
    October 17, 2010 10:07 am

    Enough debate already!! Nurses have long been denied the dignity of professional status because many do not have bachlaurette degrees. There will always be a shortage as long as we short change ourselves! The VA has the right idea and as providers of the nations universal healthcare system for our veterans they set the bar as far as I’m concerned. Thanks for the well done article.

  • Mary Lou Brunell
    October 15, 2010 11:19 pm

    As executive of FL’s nurse workforce center, I am not certain adequate consideration is being given to the future impact of the nursing shortage. (This is not intended as an opinion on the value of advanced education.) Taking into account the impact of health care reform, Florida will face a shortage of 56,000 RNs by 2025 unless further actions are taken now-based on 2009 vacancy levels, FL’s lowest in many years. I agree there is a window of opportunity. Just don’t under value future needs.

  • Candace Campbell
    October 15, 2010 2:06 am

    A pity that a new study confirms nurse educator salaries the lowest of all faculty remuneration in the nation!

  • Your article is exactly why I have continued my education. The trend towards higher standards is not going away. Efficient use of all resources will be needed to aid the country in controlling health costs and saving the economy.

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