Statement of Bernie Gerard, Vice-President, HPAE

Re: S620, Requiring a BSN in 10

May 5, 2008

 

On behalf of HPAE, I want to thank Senator Vitale and the Committee for the opportunity to express our concerns regarding S620, as currently drafted.  Over the past years, HPAE members have appreciated your leadership and this Committee’s on a wide range of health care issues – and we have appreciated your constant support for improving working conditions for healthcare workers. 

 

The shortage of Registered Nurses demands creative solutions and programs that will increase the available pool of qualified nurses in all health care settings. At the same time, changing technology and the variety of health care settings require that Registered Professional Nurses receive continuing education to keep pace with health care demands. 

 

HPAE supports programs that seek to improve professional standards, education and practice for RNs, while increasing both the recruiting and the retention of qualified nurses. HPAE does support programs that would increase the number of BSN enrollments and graduates in our nursing programs without sacrificing the recruitment and retention of qualified associates- and diploma-prepared Registered Nurses.   However, S620 achieves its intended goal of improving professional standards and education at the expense of exacerbating our nursing shortage.

 

Since 2004, HPAE has been on record supporting programs which encourage educational advancement for RNs, while opposing mandatory requirements for RNs to acquire a BSN, due to a number of factors:

 

  1. The Nursing Shortage will be exacerbated with a BSN requirement:
    1. The one state to require a BSN (North Dakota) rescinded its legislation after more than 200 nursing students left the state.
    2. More than 70% of RNs currently practicing in New Jersey have entered the nursing profession with either Associates Degrees (AD) or from diploma schools, a trend that continues: Of the 33 schools enrolling 9000 nursing students in 2005, 6600 were in AD or Diploma programs. (NJ Collaborating Center for Nursing: NJCCN Report, 11/06)
    3. There is currently no distinction in hiring or salary in health care settings, based on RN educational background. Such a requirement may create discrimination against experienced, qualified RNs with AD or Diploma Degrees, reducing the number of nurses in active employment. 

 

  1. A BSN requirement may discriminate against working students and students from diverse ethnic backgrounds, more of whom enter the nursing profession from AD and Diploma programs.  Increasing diversity within our nursing profession is important to both increase our culturally competent workforce, as well as to increase the nursing pool. Without proper support for achieving a BSN, these students may be discouraged from entering or staying in the nursing profession. 
    1. The average annual in-state tuition for a BSN in New Jersey $11,755, a figure that surpasses the financial resources of many working nurses – particularly heads of households.  Without providing tuition reimbursement or replacement of lost income – or allowing time-off for education – many nurses will be unable to fulfill the BSN requirement and will be forced out of the profession. 
    2. In contrast, the average in-state tuition for an AD is $1750 and for a Diploma School is $5898. 
    3. According to the NJ Collaborating Center for Nursing (NJCCN,11/06) “There is a striking difference in the number of full-time vs part-time students attending each type of program.  The vast majority (91%) of generic BSN students are full-time, while most of the AD students (65%) are part-time, with the Diploma schools reporting 49% of students attending part time. 
    4. Diploma schools reported a much higher percentage of Black Students (30%) than either AD (18%) or BSN (18%).  Of students enrolled in RN programs in 2005; 23% are Black, non-hispanic – of those 52% are in Diploma programs; 26% in AD programs and 22% in BSN programs. 

 

  1. There is no distinction in the  clinical qualifications and practice  between Associate Degree RNs, Diploma School graduates, and BSNs:
    1. Entry into the nursing profession is the same for all RNs, whether they have graduated with an AD, Diploma School, or Bachelor’s degree.  The NCLEX exam for licensure makes no educational distinction – and all nurses must pass this exam to practice in NJ. 
    2. There is no distinction in scope of practice, in law or regulation, between different educational backgrounds for RNs. 

 

  1. Nursing schools cannot currently accommodate the influx of nursing students with the passage of a state-mandated BSN requirement, and educational requirements and the lack of uniformity in transferable credits often hinder the process of advancing to a BSN from AD or Diploma programs.
    1.  NJ Nursing Schools are currently turning away qualified applicants due to factors that include a faculty shortage and budget cuts that hit disproportionately at BSN programs.  (NJCCN Report, 11/06).
    2. According to the same report, 21% of qualified applicants were turned away from NJ programs in 2005. 
    3. There is no standardization for acceptance of all credits accumulated through an AD or Diploma programs, adding to the time and expense for a graduate of an AD or Diploma program to acquire a BSN.
    4. There is no standard for awarding credits based on years of clinical experience for RNs who graduated from an AD or Diploma program.

 

HPAE does support programs which encourage the least costly and most accessible entry into nursing for all students – particularly those who are already working in the industry,  minority ethnic groups and working students.  State policies need to encourage pathways into the nursing profession for qualified candidates that are accessible, affordable and increase diversity and economic sufficiency for a mostly female workforce. 

 

We strongly encourage supports from employers and state and county governments to help practicing nurses, and health care workers  advance their education.  Before consideration of a BSN requirement, HPAE would encourage the adoption of the following state and employer programs:

 

1.      Provide pre-paid tuition for RNs advancing their degrees, through employer-subsidized programs and state funding where possible;

2.      Provide paid leave-time for RNs who seek to advance their degrees, with a commitment to continued employment in return;

3.      Provide work-school programs for healthcare workers who wish to acquire nursing degrees.

4.      Assess the capacity of our current Schools of Nursing to accept the number of nurses each year expected to return for a BSN degree;

5.      Develop work-study programs and financial assistance programs to increase the number of students able to attend school on a full-time basis, as proposed by the NJCCN; 

6.      Develop programs to increase the number of nursing faculty commensurate with the anticipated need. 

7.      Develop a uniform policy for acceptance of credits from AD and diploma programs for BSN programs, and a system for awarding credits based on years of clinical experience.

 

We therefore respectfully ask that you hold S620, until further discussions with nursing unions, faculty and other nursing leadership groups on ways to achieve the goals of S620; and first seek to develop policies and programs that would achieve the goal of matching high educational standards to the recruitment and retention of qualified nurses for patient care needs.

 

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