AACN - Publications - Issue Bulletin

With the Bureau of Labor Statistics projecting the need for more than 580,000 new and replacement registered nurses by the year 2018, nursing schools around the country are exploring creative ways to increase student capacity and reach out to new student populations. The challenge inherent in these efforts is to quickly produce competent nurses while maintaining the integrity and quality of the nursing education provided.

One innovative approach to nursing education that is gaining momentum nationwide is the accelerated degree program for non-nursing graduates. Offered at both the baccalaureate and master's degree levels, these programs build on previous learning experiences and transition individuals with undergraduate degrees in other disciplines into nursing.

Shifts in the economy and the desire of many adults to make a post-September 11 difference in their work has increased interest in the nursing profession among "second-degree" students. For those with a prior degree, accelerated baccalaureate programs offer the quickest route to becoming a registered nurse with programs generally running 12-18 months long. Generic master's degrees, also accelerated in nature and geared to non-nursing graduates, generally take three years to finish. Students in these programs usually complete baccalaureate-level nursing courses in the first year followed by two years of graduate study.

Though not new to nursing education, accelerated programs have proliferated over the past fifteen years. In 1990, 31 accelerated baccalaureate programs (BSN) and 12 generic master's programs (MSN) were offered around the country. Today, 230 accelerated BSN programs are operating and the number of generic master's programs has increased to 65. According to AACN's database on enrollment and graduations, 33 new accelerated BSN programs are now in the planning stages. This number far outpaces all other types of entry-level nursing programs currently being considered at four-year nursing schools. Six new generic master's programs are also taking shape.

Graduates of accelerated programs are prized by nurse employers who value the many layers of skill and education these graduates bring to the workplace. Employers report that these graduates are more mature, possess strong clinical skills, and are quick studies on the job. Many practice settings are partnering with schools and offering tuition repayment to graduates as a mechanism to recruit highly qualified nurses.

The typical second-degree nursing student is motivated, older, and has higher academic expectations than high school-entry baccalaureate students. Accelerated students excel in class and are eager to gain clinical experiences. Faculty find them to be excellent learners who are not afraid to challenge their instructors.

"Our accelerated students are a remarkable group," said Nancy DeBasio, PhD, RN, Dean of the Research College of Nursing in Kansas City. "Their mean GPA is 3.3, they come from a wide array of backgrounds, and the experiences they bring with them enrich their nursing." The compressed program format is a key motivator for this group of students. "Our exit surveys indicate that the one-year program completion time is a primary reason for enrollment in our program," Dr. Debasio explained.

Second-degree students bring new dimensions to nursing and a rich history of prior learning. "We are seeing a steady increase in applicants to our accelerated program this year, and those accepted come with backgrounds that are varied and impressive," said Janet B. Younger, PhD, RN, Associate Dean of the School of Nursing at Virginia Commonwealth University. "We welcomed several PhDs, some MDs from other countries, and a few fine arts majors. These students excel in class and perform very well post-graduation."

Students in accelerated programs are competitive, maintain high grade point averages, and almost always pass the NCLEX-RN licensure exam on the first attempt. "Second-degree candidates are excellent students and are very likely to see the program through to graduation," said Afaf Meleis, PhD, RN, FAAN, Dean of the University of Pennsylvania School of Nursing. "These students are committed to their studies, are actively engaged in research, and very often involved in university organizations."

Susan M. Di Biase, CRNP, MSN, a faculty member at Jacksonville State University in Alabama, knows a thing or two about second-degree students. She was one. "As a nurse educator, I have taught dozens of second-degree students who often distinguish themselves as class leaders," explained Di Biase. "When I was taking classes, I thought the students were strong academically and many said nursing was harder than their first degree. My first employer made a custom of hiring second-degree students because she thought they were good thinkers and strong patient advocates."

Accelerated baccalaureate programs accomplish programmatic objectives in a shorter time frame than traditional four-year programs, usually through a combination of bridge courses and core content. Instruction is intense with courses offered full-time with no breaks between sessions. Students receive the same number of clinical hours as their counterparts in traditional programs. Admission standards are high with programs typically requiring a minimum of a 3.0 GPA and a thorough prescreening process.

Typically, students with a prior degree are not required to take the liberals arts content included in a four-year BSN program. Accelerated programs do require prerequisites, many of which may have been completed during the student's initial degree program. "Before students can begin our program, their college transcripts are reviewed to assure that all prerequisites are met," stated Maureen C. Creegan, EdD, RN, Nursing Program Director at Dominican College (NY). "Almost all students meet the arts and social sciences requirements; most do not meet the natural sciences requirements, including anatomy and microbiology. To assist students, we offer back-to-back prerequisite courses just prior to the start of the accelerated program."

Accelerated programs require a heavy credit load and intense clinical experiences. Identifying students who will flourish in this environment is a priority for administrators. "Due to the intensity of the program, an interview was added to the admission process to better screen students," explained Maryann Forbes, PhD, RN, Accelerated Baccalaureate Program Director at the State University of New York-Stony Brook. "Faculty feel that the interview and ongoing mentoring are key components to student success."

"The most successful accelerated students are bright, inquisitive, and sophisticated consumers of higher education who actively pursue learning opportunities," said Harriet Feldman, PhD, RN, FAAN, Dean of the Lienhard School of Nursing at Pace University (NY), whose Combined Degree Program (BSN/MS) has been in existence since 1984. "As adults, these students tend to know what they need and aggressively pursue programs that best meet their needs: fast-tracked, competitive, and well respected. While some students do attend part-time, most are full-time students who want to reach their career objective as quickly and efficiently as possible."

"Our accelerated BSN program attracts second-career seekers who are unable to make the time and financial commitment to a generic master's program," explained Elizabeth McGann, DNSc, RN, CS, Dean of the Department of Nursing at Quinnipiac University (CT). "Our program gives students the option of entering basic nursing practice now with graduate education as a potential future step."

Having already completed a degree at the baccalaureate or graduate level, many second-degree students are attracted to the generic master's program as the natural next step in their higher education. "Why would a bachelor's prepared applicant, thinking about a career in health care, want to get a second bachelor's in nursing when they can get a professional master's or doctorate in every other health care field?," asked Melanie Dreher, PhD, RN, FAAN, Dean of the University of Iowa College of Nursing. Recently approved by the state board, Iowa's professional Master's Degree in Nursing and Healthcare Practice may be completed in four semesters including a semester-long clinical internship that occurs five days a week for three months.

"In 1974, Yale University was the first school to open its door to college graduates who were not yet nurses and instituted the Graduate Entry Prespecialty in Nursing (GEPN)," explained Sharon Sanderson, Director of Student Recruitment for Yale's School of Nursing. "We recognized that bright, committed people without a background in nursing could be prepared as advanced practice nurses." At Marquette University in Wisconsin, students admitted into the direct-entry MSN program are high achievers. "Our students are self motivated, have definite goals, demonstrate good study habits, and succeed," explained Judith Fitzgerald Miller, PhD, RN, FAAN, Interim Dean of the College of Nursing.

"Our generic MSN students bring a wonderful expertise to the class," said Margery Chisholm, EdD, RN, CS, ABPP, Dean of the School of Nursing at MGH Institute of Health Professions in Boston. "We run the gamut from a 53 year old male lawyer, students holding PhDs and master's degrees in other fields, and students fresh out of a liberal arts program. One of my past students was a horticulture major who wrote a paper on therapeutic gardens for health care settings. As they learn from us, we also learn from them, and they learn from each other. Second-degree students are a challenging, exciting group with the potential to make significant contributions to nursing as well as to their patients, families and communities."

Interest in generic MSN programs is running high. In Chicago, the DePaul University's program grew from 20 students last year to 48 students this fall with a minimal amount of advertising. "With little more than a one-sentence notice about the program on the school's Web site when the program was announced, we received over 100 inquiries and more than 40 applications in short order," said Kathryn Anderson, PhD, RN, Graduate Program Director at the Seattle University School of Nursing. "Based on this initial response, it's obvious that the most effective marketing tool is the program itself."

Many universities offer both accelerated baccalaureate and generic master's programs with opportunities for students to apply credits to both degree programs. New York University, for example, offers a dual degree program that enables BSN students to take a maximum of nine credits at the graduate level while completing the bachelor's degree, thus accelerating the completion of an MSN.

Nurse employers recognize the value and skills second-degree students bring to the work setting as evidenced by the growing number of partnerships forming to support these graduates. "Our cooperative relationship with Poudre Valley Hospital brings the educational and practice settings closer together with clinical nurses at the hospital serving in faculty roles," explained Sandra Baird, EdD, BSN, Director of the School of Nursing at the University of North Colorado. The school is working to branch out and establish cooperative relationships with a wider network of health care settings.

"Second-degree students are a very attractive catch for any health care institution and many are willing to fund them in exchange for work commitments after graduation," said Donna Ayers Snelson, MSN, RN, Chair of the Nursing Department at College Misericordia (PA)." Although Creighton University (NE) is a private institution with a significantly higher tuition than public institutions, the reputation of its program led two Omaha health systems and four rural hospitals to offer full tuition scholarships to accelerated nursing students in exchange for employment commitments. "Over half of the students in the accelerated baccalaureate program accepted tuition scholarships from area hospitals in return for a commitment to work in basic practice prior to going on for a master's degree," added Linda Cronenwett, PhD, RN, FAAN, Dean of the School of Nursing at University of North Carolina-Chapel Hill.

Research College of Nursing uses both grant-funded initiatives and clinical connections to build student capacity. "Recently we received a $100,000 grant from the Helene Fuld Health Trust to support financial aid for our accelerated students," said Dean Nancy DeBasio. "Fuld had never supported this type of student before, but we were able to demonstrate that these students were economically disadvantaged, not always eligible for traditional undergraduate funding, and unable to work due to the program's intensity." The school also partners with a local health care system to secure educational debt repayment for accelerated students in exchange for work commitments. It is projected that this arrangement will save the health system more than $3 million in nurse recruitment costs over three years.

Though accelerated programs have proven to produce highly qualified nurses, the programs do present some unique challenges to nursing education. "Teaching accelerated students can be challenging because of their experience, age, and high level of inquiry," said Mary E. Pike, MSN, RN, faculty member at Bellarmine University (KY). "Some students struggle with the transition from being a competent, worldly adult to returning to life as an undergraduate student." One key to facilitating this transition and encouraging student success is using experienced faculty who are comfortable teaching adults.

In instances where employers are not repaying educational debt, the cost of an accelerated program can be prohibitive. "I receive many inquiries about our accelerated program, but the lack of financial aid is the major deterrent," said Arlene G. Wiens, PhD, RN, Nursing Department Chair at Eastern Mennonite University (VA).

Some find the pace of accelerated programs to be too intense and opt for more regularly paced programs offered for second-degree nursing students. "The accelerated format is taxing, and some find it too difficult to assimilate into their daily routines," said Louann Zinsmeister, DNSc, MSN, RN, instructor at Messiah College (PA). "These students often transfer into a more traditionally paced two-year BSN program that permits them to continue working and attend to family responsibilities while completing a nursing degree."

For students who cannot accommodate full-time study, schools are looking for creative alternatives. "We are opening a part-time evening program so second-degree students and adult learners can obtain a degree while working full-time," added Donna Ayers Snelson of College Misericordia. "Students attend classes two nights a week and are still able to obtain a nursing degree in two years and one semester."

In addition to nursing skills, second-degree students bring additional layers of education and significant work experience to their role as nurses which enhances their clinical practice. "Initially when we began our program in 1991, our clinical partners were quite doubtful about what we could produce in one year," explained Dr. DeBasio of the Research College of Nursing. "Now they are at our doorstep each year to snap up students as they graduate." The college has tracked students through their careers and found that accelerated students move into management positions more quickly and generally excel in their roles.

"Employers of advanced practice nurses (APN) are equally pleased with graduates from both our traditional and generic MSN programs," stated Linda D. Norman, DSN, RN, Senior Associate Dean for Academics at Vanderbilt University School of Nursing. Employers rated Vanderbilt's MSN graduates who did not have a nursing background equally high in terms of level of preparation for APN positions as those who entered with a BSN degree.

"We know that employers love hiring accelerated graduates because they are bright, have a track record of success, and possess an understanding of the work world not always found in younger students," said Patricia Ladewig, PhD, RN, Dean of the School of Health Care Professions at Regis University in Denver. "We have found that second-degree students are readily accepted by employers who understand that these graduates lacked only vacation during their academic program," confirmed Sandra S. Angell, MLA, RN, Associate Dean for Academic and Student Support Services at The Johns Hopkins University School of Nursing.

With a greater number of second-degree students turning to nursing, the demand for accelerated programs is growing. At the University of Pennsylvania, application trends over the past 6 years show a 34% increase in applications from 1995-2001. "Within two weeks of the program's approval by the state board and without any public announcement, we received more than 50 requests for applications almost immediately," explained Marianne W. Rogers, EdD, RN, Chairperson for Nursing at the University of Southern Maine.

"Our program is growing very quickly, and we have seen almost a 100% increase in applications compared to last year," said Linda A. Bernhard, PhD, RN, Associate Dean for Undergraduate Studies at The Ohio State University. The 16-month Second Career/Second Degree program in nursing at Wayne State University in Michigan experienced a 25% increase in enrollment from Fall 2000 to Fall 2001 making it one of the school's most popular degree offerings. Enrollment in the University of Virginia's second-degree program has doubled since it was introduced in 1988.

"At this time, we are seeing an enormous increase in the numbers of applicants with bachelor's degrees applying for our new 12-month accelerated pathway to the BSN," reports Christena Langley, PhD, RN, Assistant Dean for Undergraduate Programs at the College of Nursing and Health Science at George Mason University (VA). "Many of them are recent college graduates who are looking for the quickest route to the BSN. They are confident that they can adapt to the accelerated pace given their past success in college."

Second-degree students bring a wealth of knowledge, experience, and energy to the nursing workforce and are highly skilled clinicians. With calls for nursing schools to produce more graduates in response to the nursing shortage, a similar call should go out to employers and legislators to increase support for accelerated nursing programs.

Hospitals, health care systems, and other practice settings are encouraged to form partnerships with schools offering accelerated programs to remove the student's financial burden in exchange for a steady stream of new nurse recruits. Legislators on the state and federal levels are encouraged to increase scholarship and grant funding for these programs that produce entry-level nurses faster than any other basic nursing education program. These programs are ideal career transition vehicles for those segments of the labor force impacted by recent fluctuations in the economy.

"The overwhelming response to our accelerated programs demonstrates the existence of a deep pool of career changers available to nursing," said Gloria F. Donnelly, PhD, RN, FAAN, Dean of the College of Nursing and Health Professions at Drexel University (PA). "We need to do more to remove barriers and attract more second-degree students to the nursing profession."

AACN is available to assist nursing schools interested in launching accelerated BSN and MSN programs by putting you in touch with curriculum specialists and program administrators. To find out more, please contact rrosseter@aacn.nche.edu or (202) 463-6930, extension 231.