For Rita Glazebrook, a professor of nursing and department chair at St. Olaf College, the importance of future nurses having bachelor's degrees in nursing is evidenced not only by statistics but anecdotes. Glazebrook recalls a nursing student who was caring for a patient from a different cultural background. Initially, the patient wasn't very communicative with doctors or nurses. The student, who had a strong musical background, thought it might be beneficial for the patient to listen to music and began to play CDs in the hospital room.

"It was only through music that the patient began to tell their story," Glazebrook said. "That background in the arts also allowed the student to see the complexity of the patient's situation and to begin to understand how the patient's culture impacted the plan of care."

Glazebrook's example demonstrates how students at St. Olaf (and at Gustavus Adolphus College, which together comprise the Minnesota Intercollegiate Nursing Consortium or MINC, which Glazebrook directs) and their future patients benefit from holding a four-year degree.

And it's a similar story at all nine of the Minnesota private colleges and universities that offer baccalaureate degrees in nursing. As the state’s largest source of students with these degrees, Minnesota Private College Council member institutions all combine liberal arts, rigorous nursing coursework and clinical experiences. The result isn't just graduates who are well-rounded individuals — the students are also likely to become better registered nurses (RNs) when they enter the field.

"The baccalaureate-degree RN has more experience with critical thinking skills, problem solving, coordinating care and more leadership management skills than a nurse with an associate degree," Glazebrook said. "It's that whole notion of being holistic, of considering the physical, emotional, mental, sociocultural and spiritual aspects of a situation, that the baccalaureate nurse excels at."

Polly Kloster, chair and associate professor of nursing at Concordia College, agrees. Kloster emphasizes that today's health care environment is especially challenging and requires more knowledge and skill than ever before. "A baccalaureate degree provides a strong background in nursing theory and clinical skills with the addition of a range of coursework outside the discipline. Because nurses are expected to be well-prepared to function effectively as team members and to provide care for diverse populations, the combination of coursework expands their worldview to meet these challenges."

In addition, some requirements of a liberal arts education, like learning a language, become assets nurses make use of every day in their practice. Kloster said some nursing students at Concordia College choose to take additional language coursework so they are better equipped to work with diverse populations.

A need for degrees

Indeed, the need for more RNs with Bachelor of Science in Nursing (BSN) or Bachelor of Arts in Nursing (BAN) degrees in Minnesota and nationally has been recognized by many health care organizations. The American Association of Colleges of Nursing emphasizes the baccalaureate-level nurse as essential to the profession and has placed increased focus on a four-year degree being the basic level of education that new RNs need. In 2010, the Institute of Medicine released a report calling for 80% of RNs in the U.S. to hold a baccalaureate degree or higher by 2020. In addition, hospitals are increasingly requiring new RN hires to have or be working towards bachelor’s degrees.

"I think we have to graduate more nurses at the baccalaureate level while also being really specific about the skills and education needed at each level of nursing," said Penelope Moyers, dean of the Henrietta Schmoll School of Health at St. Catherine University.

Currently, however, about 50% of RNs nationally hold a baccalaureate degree, according to the 2008 National Sample Survey of Registered Nurses. The estimate of RNs in Minnesota holding a BSN or BAN degree is between 15 and 25%, less than half the national average, according to Marty Witrak, professor and dean of the school of nursing at The College of St. Scholastica.

Having RNs with bachelor's degrees by patients' bedsides can also have positive results that are measurable. Many studies have linked having a high number of baccalaureate-prepared RNs in hospitals or clinics to better patient outcomes, Witrak said. "(Having more nurses with such degrees) has been correlated with fewer medical errors in acute care situations and lower mortality rates in cardiac care units and other settings."

So, besides the obvious answer of more education, what factors might contribute to these differences in patient outcomes? "In those additional years, you're not just learning skills," Witrak said. "Becoming technically competent is important, but you want students to know why they're doing what they're doing and what to look for if it's not going right. That comes from a strong liberal arts base."

Witrak said a situation where such knowledge might be essential is in preventing hospital-acquired infections, which have been on the rise recently. In addition to using good sterile techniques, preventing such infections requires nurses to look beyond the obvious to determine why infections might be occurring — and then to analyze all the possible ways to solve the problem.

A nurse with an associate degree would know the technical skills, but might not be as strong of a critical thinker or leader. "There's a place for everyone in nursing, but the education received (at each degree level) is different," Glazebrook said.

A shortage of nurses, but plenty of challenges

Having a highly qualified nursing workforce is especially important because of the impending nursing shortage, both in Minnesota and nationally. An estimated 260,000 more RNs will be needed by 2025 nationally, according to a 2009 article in the journal Health Affairs. The shortage will likely stretch the responsibilities of those already in the field; at the same time, nurses will have to respond to the changing demographics and needs of their patients.

"The nursing shortage is probably being delayed right now because people are holding off on care for economic reasons, but those health problems aren't going away," Witrak said. "Baby boomers will continue to be an aging demographic and more nurses will be needed."

Because many of them are older, patients entering hospitals today and in the future will likely have multiple health issues, making management more complex. There will be more people who are very sick and at the end of their life, Witrak said. And the nursing workforce is aging as well, contributing to the shortage.

Nursing departments at Minnesota's Private Colleges are responding to this demand in various ways. At St. Olaf and Gustavus, MINC has maximized its enrollment in nursing programs while still maintaining high four-year graduation and near-zero attrition rates, Glazebrook said. At St. Scholastica, Witrak said enrollment has "doubled, if not tripled" in the past few years and Kloster notes that Concordia has nearly doubled its enrollment over the past six years.

In addition, St. Scholastica and Concordia both have accelerated degree programs for individuals who have a baccalaureate degree in another area and want to enter the nursing field as soon as possible. "An important solution (to the shortage) will be to continue to move nurses toward attainment of the baccalaureate degree through ladder programs," Kloster said.

Moyers agrees. "Programs that offer intentional and seamless laddering to different licensure and education levels are very important."

Specific areas within the profession are also likely to experience shortages of RNs in the coming years. RNs who can work in rural settings, with diverse populations, with the elderly and with patients who are critically ill will be in increased demand. At St. Scholastica, Witrak notes that the nursing department has been proactive in responding to the need for training in these areas, having received several federal grants to bolster their emphasis on rural healthcare and their geriatric nursing track.

Concordia College works to expose future nurses to diverse populations in the area so that they can better meet these communities' needs in the long run, Kloster said. This includes working with Native American, Somali, Bosnian, Iraqi and Chinese populations in the Fargo-Moorhead area.

The solution to the nursing shortage — and the need for more nurses with baccalaureate degrees — is likely to be complex and will take time, but nursing programs at Minnesota's Private Colleges are prepared to meet the challenge. "Colleges must be a part of the solution because they produce the nurses who will fill the vacancies to address the shortage," Kloster said.