Expanding nurses' access to a bachelor's degree in Colorado

Colorado, like many places around the country, needs more nurses faster than colleges and universities can prepare them for practice. Cities like Pueblo, Fort Collins, Colorado Springs, and Grand Junction are projected to feel the shortage the most acutely, lacking enough nurses to meet patients’ needs. The most expedient way to prepare new registered nurses for the profession is through two-year associate degree programs. Moving students through associate programs in nursing and getting them into the field quickly can help Colorado address the number of new nurses they need working in the state.

But there’s another dimension to the nursing shortage: access to higher degrees. A growing body of research points to better patient outcomes in facilities where most nurses have a bachelor’s degree in nursing (BSN). This research led the Institute of Medicine to publish a landmark report in 2010 calling for 80 percent of nurses to hold a BSN by 2020. Colorado is not only running short on the sheer number of registered nurses in the state. It’s also running short on nurses with a BSN and needs between 500 and 750 more BSN-prepared nurses per year from 2015 to 2024 to meet the state’s health care needs. While it’s clear that the associate degree is an indispensable pathway into the nursing profession, it’s critical to offer nurses opportunities to access further education. In fact, New York state passed legislation in 2017 requiring registered nurses who enter the profession with an associate degree to get their BSN within ten years or risk losing licensure. Thus far, New York hasn't taken concrete steps to address colleges’ capacity to offer these degrees in flexible and affordable ways.

But Colorado has. The state’s strategy to tackle the nursing shortage and simultaneously encourage BSN attainment across the state? Recently passed legislation made Colorado the tenth state to allow community colleges to offer BSN completion programs for current nurses.

Such “bridge” or “RN-BSN” programs--designed for nurses with an associate degree to earn a bachelor’s degree--build on nurses’ existing foundation of technical patient care skills with classes in research, nursing theory, community and public health, and care management. There are currently around 750 RN-BSN programs across the country, most offered at least partly online. But still, not enough nurses are completing RN-BSN programs to keep up with the need for BSN-prepared nurses in the field. Nurses cite high cost, time, and the difficulty of integrating work, school, and family roles as reasons for not pursuing the degree. In fact, over half of Colorado nurses who enter the profession with an associate degree don’t move on to a bachelor’s program. But community colleges that offer RN-BSN programs are well-positioned to change that.

Currently, almost half the Colorado nurses who pursue a BSN after an associate degree turn to out-of-state institutions to do so. The average yearly tuition of $16,000 at a for-profit institution and nearly $25,000 for an out-of-state public institution makes it easy to understand why so many nurses balk at the price tag for an RN-BSN program. But the average cost of a year’s tuition at a local community college totaled only $3,470 in 2017, which is much more likely to be manageable for nurses. In fact, New America’s 2017 Varying Degrees survey indicated that over 80 percent of respondents believed a community college education was worth the cost, the highest rate of any higher education sector.

The same survey also indicated that public trust of community colleges is strong, at a time when perceptions of higher education in general are a bit more skeptical. Over 60 percent of respondents believed that community colleges always put their students first, topping all other sectors. Specific to the field of nursing, a recent study by Emsi found that the clear majority of nurses interested in returning to school for a higher degree would prefer to do so at a community college. For Coloradan nurses, this means the opportunity to pursue a bachelor’s degree at a familiar, trusted institution can offer the community and support they need to tackle work, school, and family life all at once.

Over half of current RNs across the country began their education at a community college, and it’s important to maintain the associate degree as an entry to a nursing career. But it’s also critical to enhance nurses’ skills and knowledge through accessible bachelor’s degree completion programs. Colorado’s recently passed legislation allowing RN-BSN programs at its community colleges puts it in a cohort of states wisely leveraging the affordability, local connections, and public trust of community colleges to support nurses’ path to the bachelor’s degree and state residents’ access to the health care they need.