Nursing schools toughen programs

New standards may worsen RN shortage

By Sarah A. Webster / The Detroit News >    DETROIT — Faced with the widening nursing shortage, Metro Detroit nursing schools are stepping up efforts to attract students by offering more scholarships and partnering with local hospitals to meet their recruitment needs.

    But at the same time, the programs are raising standards for entry and graduation from nursing schools, resulting in the rejection of hundreds of applicants who lack the necessary basic educational requirements.

    Health care, some educators argue, is constantly advancing and so should the requirements to become a nurse. Registered nurses today must have a strong foundation in math and science, they say, and those high school graduates who don’t have the proper basic skills should be rejected despite their interest.

    “We have very rigorous standards,” explained Barbara Redman, dean of the Wayne State University nursing school.

    Hospitals and working RNs support the higher bar, although it may strain the shortage by hindering new nurses.

    “They hold patients’ lives in their hands,” explained Don Potter, president of the Southeast Michigan Health & Hospital Council.

    “It’s chest tubes, and the EKGs, and the different IV pumps with the different drips,” said Roxann Louden, a St. Clair Shores nurse. “You really have to be strong in order to know that you’re programming that machine correctly when you walk away.”

    Nursing schools have stepped up efforts to attract suitable candidates. Scholarships are flooding the field, including an infusion of federal funds to ease the shortage. Virtually every hospital in Southeast Michigan is partnering with nursing schools to support the education and recruitment of new nurses.

    “We have over 100 scholarships and loan programs,” said Christine Zambricki, a chief nurse executive and nurse anesthetist with William Beaumont Hospital in Royal Oak.

    Still, many area nursing schools do not meet their capacity for enrollment and many of their students don’t graduate.

    Mary Bray, a full-time recruiter for Oakland University’s nursing school, said the curriculum today is tough and comparable to a pre-medical program. In fact, some future doctors are now opting for a nursing degree instead.

    Some nurse recruiters worry the field is not attracting the right students because perceptions of nurses haven’t changed along with the career’s high-technology realities. Many candidates with strong math and science skills, she said, are often guided into careers like engineering or they become doctors.

    Bray, whose position is partially funded by Beaumont, and others are trying to educate students on the realities and drawing points of nursing. Because despite the field’s problems, it does have advantages — such as job security and a fulfilling public service role.

    “A lot of students want to get into a career where they know there will be demand, which is very true for nursing,” Bray said. “They will always need nurses 24-7.”

    Moreover, while staff nurses complain about their pay, there are opportunities for high incomes in nursing specialities that aren’t well publicized. Nurse executives, nurse practitioners, nurse midwives and certified registered nurse anesthetists, known as CRNAs, are highly compensated professionals.

    James Scarsella, chief nurse anesthetist at St. John Hospital & Medical Center, said CRNAs must have a bachelor’s degree in nursing and then complete a master’s degree that takes about 30 months. The base salaries for CRNAs in Metro Detroit are about $110,000.

    “You can make a lot more if you want to,” Scarsella said.

    Yet there are major shortages of CRNAs, too. The health care industry needs to double the graduation rate of CRNAs to meet demand.

    “There are pretty much openings in every hospital,” Scarsella noted.

    At the same time there are difficulties recruiting enough nurses into educational programs, some nurses are trying to make licenses more difficult to obtain.

    “The need for knowledge is just increasing all the time,” said Zambricki, who still spoke against an increase in standards for CRNAs because of shortages. “This is not the time to start delaying graduation.”

    Yet some are trying to ratchet up qualifications for even basic RNs.

    Bachelor’s degree nurses, with help from the American Nurses Association, have long been pushing to require a four-year degree as the requirement for the RN licensing exam. Currently, a student with an associate’s degree in nursing or a nursing diploma can also take the test.

    Those who support the bachelor’s-only approach base their decision on the complicated nature of health care and suggest that nurses will never be regarded as true professionals until a four-year degree is the norm. These educators have had some luck getting their way.

    In the 1960s, over 80 percent of RNs came from accessible three-year diploma programs, which are run by hospitals. That has now dropped to seven percent nationally, and there are no more diploma programs in Michigan — even though they were a steady source of RNs. Hospitals that kept their diploma programs have less staffing difficulties nationally, leading some local facilities to reconsider opening their schools, Potter said.

    “If I had diploma nurses, it would be great,” said Steve Velick, an official with Henry Ford Health System and former chief executive of that company’s flagship Detroit hospital.

    Meanwhile, one state, North Dakota, has already adopted the bachelor’s-only RN standard.

    Supporters of the associate’s degree programs rebuff attempts to shut them out, noting that they produce the majority of the nation’s nurses — and quickly. They also note that many of those nurses go on to earn their four-year degrees.

    Sharon Bernier, president-elect of the National Organization for Associate Degree Nursing, said she has seen no evidence that the four-year degree makes a better nurse and noted that two-year programs tend to be more accessible, have more minorities and cost less.

    “I feel that we have to mount some kind of counterattack,” Bernier said.

    If the bachelor’s degree nurses win this dispute, she said, RNs may have more education but there will likely be fewer nurse graduates than ever.