Just like anyone else’s journey to an advanced degree, nurses who set out to earn a BSN don’t always take the same path. With an industry-wide push to increase the number of nurses with BSN or higher credentials, many working nurses are now looking for options to get that degree—and community colleges are looking to help fill that need.
Unlike younger nursing students who might opt for a four-year program, working nurses often have families, full-time jobs, and other commitments that decrease not just their available time and funds, but their flexibility to fit in classes, clinicals, and study groups.
As a potential nursing shortage looms on the horizon and more nurses feel the pressure and the desire for a BSN degree, community colleges nationwide are beginning to offer RN to BSN programs that help nurses fit the degree program into their schedules.
According to Deborah Trautman, PhD, RN, FAA, president and CEO of the American Association of Colleges of Nursing (AACN), when the Institute of Medicine called for 80% of nurses in the workforce to have a bachelor’s degree by 2020, hospitals and health systems reevaluated their hiring practices to develop a more highly educated staff. As that deadline nears, many working RNs face a return to school for a new degree, even after many years in the workforce.
But these programs often offer other benefits to nurses who might not typically have the chance to enter a four-year program for various reasons. By reaching larger groups of nurses for these programs, community college RN to BSN programs might even increase the diversity of the nursing workforce.
When it comes to diversity in nursing, almost all sides agree on one thing—more is needed. A nursing workforce that mirrors the incredibly diverse population helps with obvious barriers like language, but also helps with smaller barriers like understanding subtle customs or traditions that have an enormous impact on health care and health practices.
Getting more educated and more diverse nurses into hospitals and health care settings will have positive impacts on patient and nurse satisfaction, safety, and the overall outlook.
In AACN’s 2014 study, Employment of New Nurse Graduates and Employer Preferences for Baccalaureate-Prepared Nurses, respondents from 461 nursing schools indicated that 79.6% of employers are expressing a strong preference for nurses with a BSN. In addition, almost half (45.1%) of hospitals and other health care settings insist new hires have a BSN.
And while the RN-to-BSN process looks different, it still brings the same educated outcome to the workforce. The more opportunity nursing students have to complete their BSN, the better the outcome.
“Community college-based baccalaureate programs provide a new pathway for registered nurses (RNs) to advance their education,” says Trautman, noting that community college RN to BSN programs can help fill the gap in BSN nurses.
And in many states where community colleges are able to offer the RN to BSN program, increases in nurses with advanced degrees are evident. According to a study by the Florida Center for Nursing, the rate of nurses who graduated from a post-licensure degree program doubled from 2006 to 2013.
The numbers reveal a population of nurses who have already completed an associate’s degree in nursing (ADN) program and passed the NCLEX exams and are now looking to gain greater depth in areas like leadership and community relations and increase their job prospects and chances for career advancement.
“There’s a need and we are filling that need,” says Suzanne Beltz, PhD, RN, GCNS-BC, CNE, program chair of Bellevue College’s RN to BSN program. “We are just offering people a different route.”
And the programs appeal to nurses for whom the four-year programs aren’t possible so the programs open a door that was previously closed to many.
“This gives us another opportunity to reach more students,” says Linda Miles, interim associate vice president of Daytona State College’s College of Health and Public Services. “The whole idea is to increase the number of students. We meet the needs of a student who couldn’t enroll in another program.”
Speaking specifically about Florida, Miles says a concerted effort to raise the percentage of citizens who held a baccalaureate degree resulted in new opportunities for community colleges to offer the RN to BSN programs. But the process for colleges isn’t always easy; so many bristle when they hear some people question the rigor of their course work. Community colleges aren’t willing to create new curriculum, get accredited, and attract new students without producing a top-notch, competitive program, says Beltz.
Although nurses emerge with the same degree from any BSN program, the path to a BSN does not look the same in a community college as at a four-year university or college. In fact, although the end result is the same, student experiences are quite different in the programs.
Gwen Alcorn, dean of health sciences at the College of Central Florida says students entering the programs might not study the material in the same order, but all the material is covered. A traditional entry-level BSN means the student comes to the program with no license and will sit for the NCLEX licensure exams after graduation where they graduate with a bachelor of science in nursing, Alcorn says.
“It’s just a different pathway,” says Miles. In typical community college programs, nursing students enter the RN to BSN program as a completion program. They have already earned an associate’s degree, have passed the NCLEX exams for the RN designation, and often have work experience. After graduating from a BSN program, students aren’t required to retake the NCLEX exams.
The ADN program is very task oriented, says Beltz, and depending on how a particular nursing student works and his or her confidence level, these task-oriented semesters can be a real advantage. Because they have the experience that got them to the RN level, they approach the BSN program’s classroom learning with real-life, hands-on nursing experiences.
For students who learn by doing, the RN to BSN approach can be transformative. “They can sit for the board and pass to become an RN,” says Beltz. “Then the monkey is off their backs to pass the boards. Now they have an opportunity to focus on learning that isn’t just for the boards. They can pay more attention to the leadership principles and the management principles like how to make an assignment.”
Class assignments, says Beltz, are then based heavily in realistic approaches like conflict resolution or budgeting for your unit, rather than strictly theory or research.
In an entry-level BSN program, hands-on clinicals come after several semesters of theoretical learning. In the RN to BSN programs, that schedule is flipped. Nurses gain their hands-on care of patients in the earliest semesters of the associate’s program. In the RN to BSN program, they then delve into the theoretical approaches, leadership and management practices, and the complex dynamics of community, economics, and politics that impact nursing and patient care.
By earning an associate’s first, students often bring a real-world understanding of the theories they are learning about to their classes. RNs who have the clinical exposure have had the time and opportunity to identify their interests, strengths, and weaknesses and are often able to tailor their BSN program to more closely direct their career goals.
A community college can help students forge a path that maybe they couldn’t have access to at a four-year program and can help them shore up skills that might not have been addressed in the associate’s program. While many BSN programs at four-year institutions complete writing intensive courses in the first couple of years, for instance, RNs don’t all have that background. So an RN to BSN program can help eliminate that barrier.
Writing skills, says Beltz, aren’t emphasized in an associate’s program, where other skills are highlighted more. Bellevue’s diverse student population comes from places as far-flung as India, Japan, China, and Vietnam, so she understands how a lack of proficiency in writing clearly can hurt the nursing career of someone who speaks English as a second language.
You don’t have to be a good writer to become an RN, but to advance to the BSN level, being able to communicate clearly and concisely through writing is essential and often expected. Writing in a language that isn’t your first language can pose a particular challenge, says Beltz, so directing attention to nursing duties and classwork where good written communication is essential helps the nurse and increases accurate communication.
Miles says an early program evaluation revealed that many stakeholders wanted to see very specific offerings in the school’s new RN to BSN program. In addition to a rigorous curriculum, many replies indicated that the program needed to be flexible and convenient so students could work around family and work obligations.
And although a community college program is competitive academically, it’s generally less threatening, says Beltz, for several reasons. Open enrollment takes some pressure off fitting in application deadlines, and close locations and lower tuition can make a big difference.
“These programs are expected to produce graduates with the same level of competency as graduates from traditional four-year programs,” says Trautman. “The Commission on Collegiate Nursing Education (CCNE), the nation’s premiere accrediting body for baccalaureate and higher degree nursing programs, measures quality in community colleges-baccalaureate programs using the same criteria applied to four-year schools.”
But another factor that came up had to do with something closer to home, says Miles. Familiarity with the program and the college featured prominently in the students’ wishes.
Trautman agrees, noting that many community college programs are especially attractive to students who have graduated from a school’s ADN program. In fact, says Miles, she sees that trend clearly at her own school. “Many who are in the last semester of the ADN are applying to the program,” she says.
And while there are students ready to fill programs, there’s still a need for faculty to teach this new crop of BSN nurses. “Community colleges looking to offer baccalaureate level nursing programs will likely face the same challenges that four-year programs do, including finding sufficient numbers of faculty and clinical placement sites,” says Trautman. “AACN encourages collaboration between community colleges and nursing programs when possible to share resources and facilitate academic progression.”
In the end, the country needs nurses and needs nurses who are well educated and highly experienced. Noting the Institute of Medicine’s 2020 goal, Alcorn says without the RN to BSN programs, states will be hard-pressed to meet that goal.
“The components are different,” says Alcorn, “but we accomplish the same objective. It’s just in a different pattern.”
If you’ve only given professional nursing associations a passing thought, it’s time to think hard about the benefits of joining one (or even two!). Many nurses find their membership is one of the most valuable resources they use in their professional—and even oftentimes personal—lives.
Nursing associations are organizations devoted to the professional and personal development of members and also to the general advancement of the profession. Associations offer extensive benefits for membership. Through a professional association you can stay current in the industry, network with other professionals, find a mentor (or become a mentor), access many services, and find opportunities for professional growth. But what many members also find invaluable is the camaraderie that you can only find with others who do what you do.
Choosing the Right Association
How do you know which association is best for you? It comes down to what you’d like the association to do for you, how it fits into your professional and personal life, and what you want to contribute to the organization.
If you’ve never joined a professional nursing organization, you can’t go wrong with a national association like the American Nurses Association. The ANA has local chapters that will let you work closely with your community and also give you access to their large and varied network of resources.
Moreover, there’s no reason not to join more than one association. If you have a particular specialty, there is likely a professional nursing association that targets your niche. Some of these include the Academy of Neonatal Nursing and the Association of Camp Nurses. The National Association of Hispanic Nurses and the National Black Nurses Association are geared toward minority nurses, and others might address the professional concerns of cardiac or OB/GYN nurses.
If you’re a student nurse, the National Student Nurses’ Association is an excellent and dependable resource on everything from scholarships to career planning to even getting an article published. They have chapters nationwide. But if you’re looking for something more local, check out your school or nearby schools for specific associations, such as the Minority Student Nurses Association (MSNA) of the University of Missouri-St. Louis or the Boston College Student Nurses Association.
Some larger organizations offer classes and lectures that can help you earn professional credits; most hold national conferences; some offer insurance benefits and student discounts; and plenty of these large organizations offer career help and networking opportunities.
As with anything else, you will get more out of an association membership if you put something into it. Get involved on a committee, go to the conference, participate in lectures and events, attend and mingle at networking events, and contribute to the newsletter.
Using the association’s resources will help you meet people and grow your own professional network, but will also help you really identify with the other nurses where you can share your professional difficulties and triumphs. If you are experiencing something, it’s pretty likely that you’re not the only one and members of an association often offer help and support you won’t find in other places.
No one likes to admit they made a mistake. Whether you mouthed off to a coworker, got caught sneaking in late, failed a huge exam, or got passed over for the promotion everyone thought you were made for, it’s tough to admit when things go wrong. And for nurses, whose jobs mean that other’s lives are in their hands, making a mistake at work can change the course of someone’s life.
A mistake has the potential to derail your career and possibly even ruin your reputation, but there are lots of things you can do that will help mitigate any lingering effects.
“Every single one of us makes mistakes,” says Renee Thompson, DNP, RN, CMSRN, CEO and president of RTConnections, LLC. Nurses in organizations that are open, reflective, and willing to change systems for better outcomes are much more likely to report errors and prevent future mistakes.
Nursing workplace issues are distinctly different from some other working environments. “With nurses, one mistake has the potential of impacting someone’s life,” says Thompson, so any clinical error needs to be reported no matter how hard that is to do. But clinical errors aren’t the only way a nurse can mess up at work.
“New nurses have two fears,” say Thompson. “That they will kill a patient and that the other nurses will eat them alive with workplace bullying.” If a new nurse makes a mistake, she’s going to worry about her capability as a nurse, about her ability to protect and care for her patients, about her job security, and about her reputation. But experienced nurses are equally worried. They have a professional reputation to uphold and feel like there’s a lot at stake if they mess up.
Saving your reputation after a mistake comes down to a couple critical things—careful communication and your own actions to fix the situation.
Your Reputation Depends on Your Reaction
If the error has anything to do with a patient, Thompson says everything first needs to focus on the patient to make sure they are assessed and okay. Then, it’s time for some reflection of how the mistake happened and some reputation repair. Even non-clinical errors can impact a nurse’s working life.
What affects your reputation is partly about what actually happened, but it is also about how you respond and react to what happened. “Career management often has to do with personal branding,” says Keith Carlson, RN, BSN, NC-BC, co-founder and co-host of RN FM Radio and also known as Nurse Keith on the Nurse Keith Show. “Personal branding isn’t what people see, it’s what they experience when they are with you. How you react to a failure has a large part of how other people will react to it and how it will affect your reputation.”
In fact, because all nurses make mistakes, others probably aren’t focused on what you did wrong as much as your response. They are often sympathetic or just relieved that they aren’t in your shoes. “We think so many people are paying attention to us, but they aren’t,” says Thompson.
Make It Right
If you make a serious clinical error, you have to report it immediately. But what about those other smaller blips that impact your reputation or change how others perceive you? For instance, have you ever snapped at a coworker or a patient after a tiring week of long shifts?
“We all have the potential to treat each other in disrespectful ways,” says Thompson. If it happens, you need to fix it. “You have 72 hours to bring that up,” she continues. “Come back and say, ‘Can we talk about what happened? I feel bad about the way I treated you and lashed out.’”
Don’t assume the person you spoke harshly to will let it roll off her back, so make a sincere apology. “When someone treats you poorly, it kind of sticks,” Thompson explains.
Beth Hawkes, MSN, RN-NC, HACP, career columnist and founder of Nursecode.com, agrees. “Apologize where it’s warranted and acknowledge your responsibility,” she says. “Apologize to the right people and when you apologize, make sure it’s meaningful and specific.”
Don’t Fear Failure
Thompson, who teaches certificate review classes, says the number one reason many nurses don’t sit for a credentialing exam is their fear of failing the exam. They know the material and need the extra certification, but won’t actually take the test on the chance they could fail and others would find out.
If you have taken an exam and failed or you went for a promotion or a new position and didn’t get it, don’t let it stop you. “The worst thing to do when you fail is to give up,” says Thompson. “It’s a human thing that we like to be viewed as being competent, but we also realize we are all human and that we make mistakes. We aren’t all great at everything.”
Carlson agrees. If you keep upbeat and positive, people will mirror that attitude. “If you say, ‘I’m not a great test taker and I’m sure I can turn this around,’ that changes the tenor of the conversation,” he says. Now picture what the atmosphere might feel like if you openly berated your abilities.
Foster an Open Culture
Nurses are sometimes afraid to admit they made a mistake because they worry about their careers and their own reliability and capability. Typically devastated by a mistake, a nurse needs to be able to work through what went wrong, why it happened, and how to fix the root issue. Several factors influence if and how they will share details of an error.
There are so many reasons nurses don’t speak up. Fear of the consequences, embarrassment, or shame, are dominant. If you work in a place where mistakes are never discussed, you might be more inclined to keep quiet.
“When we are in a group or a culture, we do what others do,” says Hawkes.
A culture of openness, where nurses who make mistakes aren’t punished, shamed, or ridiculed, leads to better reporting and better outcomes. If a mistake was part of an overall system failure, then it will continue to happen if there is no one to identify and fix it.
Set an Example as a Leader
Thompson suggests that nurse leaders promote a culture of openness where nurses feel free to come to them. Leaders can let nurses know they are approachable and that if something happens, a nurse should come to them first. And leadership has the important role of stepping back and considering if the error was a system issue, says Thompson.
Leaders who can admit they made a mistake and that they didn’t make a good choice are more likely to develop a relationship with staff that is more trusting because it’s based in honesty.
Shaping your reactions to your own shortcomings or those of colleagues takes practice and awareness, says Carlson. And it also needs some careful thought. In the age of super-fast texts and tweets, thinking before you react is a sign of a good leader. “Taking a breath isn’t a sign of weakness, it’s a sign of strength,” argues Carlson.
Reflect, Don’t Ridicule
Reflection is part of reassessing what caused the mistake in the first place. But you have to do more than scratch the surface.
Did you have a bad day and snap at a patient? Well, your bad day is part of the reason you lost your temper, but Hawkes says you really need to root out what triggered your outburst. “You have to step back to learn from it,” Hawkes says. “To do that, you have to identify what pushed your buttons and what happened to precipitate that behavior. Any time your buttons are pushed, that’s a time to learn something about yourself.”
Nurses shouldn’t go over and over the mistake in their heads until they come up with feeling stupid. “Reflection is not rumination,” Thompson says. What matters is that you think about what you would do differently if you found yourself in the same position again.
Share Your Story
Sharing your own mistakes on the job is a healthy way for nurses to bring the topic out into the open. Hearing about others’ experiences helps you realize you aren’t alone and is also another way for you to learn from other nurses’ mistakes.
Thompson recalls being a new nurse and being so upset when her first patient died that she had to be escorted from the hospital. An experienced nurse, who had been through many patient deaths, walked with her outside and helped her grasp the overwhelming emotions. And although no nurse wants to lose emotional control at work, Thompson says she still feels deep gratitude to this nurse because she made her feel supported on the journey.
Hawkes clearly remembers making an error as a new nurse and the thorough tongue lashing she received from her boss. No harm resulted, but Hawkes was terrified that she could make another mistake. She considered quitting nursing, doubted her nursing abilities, and felt weighty shame. In the end, talking with other nurses over time and hearing about their own stories helped her. And, she says, making a mistake made her a better nurse.
If you are reeling from a misstep, Hawkes has this advice: “When you don’t know how to act, look to someone you admire and ask, ‘What would that person do?’ Then copy that behavior.”
In the end, making a mistake often feels like the end of the world. You might think your slip up is a topic among your colleagues, but it probably isn’t. “I think failure is hard for human beings in general,” Hawkes says, “but it’s hard for nurses because their mistakes can have such consequences. We are not making widgets. We are dealing with human lives.”
You want the job, you need the job, and you know you are the best candidate to fill that open position. Now that you’ve finally been called in for a job interview, you’re starting to get nervous.
What can you do to ace the job interview and make yourself stand out among the sea of other great candidates?
A successful job interview takes a lot of research, preparation, and practice, says Theresa Mazzaro, RN, BA, CHCR, a nurse recruiter with Adventist HealthCare.
If you are a new grad, don’t assume your lack of clinical experience is detrimental. “Don’t forget any of your other experiences you have had outside of clinicals,” says Mazzaro. Many new grads have worked in retail or in the food industry and have gained some relevant skills (e.g., customer service, managerial) that are applicable to the world of nursing, she says.
More experienced nurses should be aware of making sure they tell the whole story of their experience. Don’t assume they know what your job as an ER nurse entails. Tell them how many different roles you have mastered and what your responsibilities include. There’s a difference between being a supervisor of one person or 50. They won’t know that unless you tell them.
Look the part when you arrive. It’s better to be over-dressed than under-dressed for a job interview. Make sure you are tidy—brushed hair, clean fingernails, toned-down makeup and perfume, no stains on your clothes. Keep to the conservative side as well—no low-cut shirts or short skirts.
Be ready for a whole range of questions, says Mazzaro, and especially for behavior-based interview questions. That means doing some Google searches for common behavior-based questions that might come up so you can formulate and practice clear and compelling answers.
“You don’t always have to give an answer based on your clinical experience,” says Mazzaro. But you do have to make sure your reply answers the question. Generally, these types of questions have two parts: the action and the outcome. For example, tell how you implemented a charting plan that increased unit efficiency by 30%. “Really be prepared to give examples,” says Mazzaro.
Don’t assume your resume tells your whole story. Details matter in an interview. “If you’re an experienced nurse, we all know you can administer meds,” says Mazzaro. “But what have you done for the safety of your patients? Are you on any councils?” The interview is the time to get more into the depth of your skills. Yes, you are an ICU nurse, but tell them more—that you’re a surgical ICU nurse and responsible for the recovery of open-heart surgery patients and then explain even more, says Mazzaro. Doing so helps an interviewer see how your skills fit with the organization’s needs.
You should research the company long before the interview day. What is their mission? Do they have a value statement? Have they just received any kind of award, or did they just achieve magnet status? This knowledge helps you formulate your answers so you can show how your values align with theirs.
Of course, you want to know all this, but you have to be careful not to appear arrogant about your research, says Mazzaro. “You can say, ‘I was just curious about something I was reading,’” she says. That helps you broach the topic without making it obvious that you spent hours on their website.
Practice your answers at home, but Mazzaro says bringing notes to the interview is okay. Don’t read from them, of course, but scanning them to make sure you have included all the important points is fine. Ask about how the unit stays current and a little bit about the team and the culture. After all, you are trying to gauge if this job will be a good fit for you as well.
And, be ready for a long haul. Today’s interview process is lengthy and often includes a panel interview, possibly a shadowing time, and even tests and assessments.
To really impress your interviewers, come prepared with a portfolio that includes your resume; your transcript if you’re a recent grad; references and all contact information; and copies of any certifications, awards, and letters of recommendations you may have. Having all that information at your fingertips (even if they don’t need all of it) shows your attention to detail and your professionalism.
After the interview, thank your interviewers—all of them—with a follow-up thank you note. You can send an email, but Mazzaro says the personal touch of a handwritten note is better. She has even seen some people fill out notes before they leave and hand them to the receptionist on their way out. “These are the kinds of serious personal touches that can make or break you,” she says.
Although you might be the focus of the job interview, it’s your responsibility to let your interviewer know how you can help them and make a positive addition to their organization. “Talk about how you are going to be a part of that team,” she says. “That’s what’s going to drive it home.”
Have you ever felt like you just have nothing left to give your patients? Does a day at work feel like you’re scraping the bottom of your emotional well?
Lots of nurses have hit the proverbial emotional wall—sometimes called compassion fatigue—at some point in their careers. A nurse’s work day involves meeting the needs of others at a level that is high, constant, and often emotionally draining. If there’s nothing to replenish the physical and emotional resource, a nurse can quickly become less productive, resentful, and not only unhappy with her nursing role, but the entire nursing profession.
Even if compassion fatigue is common, it isn’t something you can just hope will pass. If you feel like your job is taking everything out of you, that’s something to take very seriously because it affects both the patients you care for and all your other relationships.
So, how can nurses deal with or even avoid compassion fatigue? Most experts says one of the biggest steps is to watch for the warning signs, recognize if you have any of them, or respect when a colleague recognizes you’re struggling. If you can do that, you can then begin to heal.
The signs of compassion fatigue are often mixed up with the normal stress felt in a typical nurse’s day, but it’s usually more pervasive. If compassion fatigue is starting to take hold, you might feel the physical signs, such as headaches or sleep problems, or the emotional signs, such as anxiety or fluctuating moods. Lots of nurses who feel the ramifications of compassion fatigue also start showing signs of it on the job, so that often colleagues notice the signs even before the nurse admits to herself that something’s wrong. Maybe you are consistently coming in late or finding ways to get out early. Or, maybe you are just noticing the dread creeping in as you get ready for work.
Anyone can experience tough times and feel one or all of these signs during the course of their careers. But if you notice this is becoming prolonged—for example, your boss has to talk to you about your tardiness, your family complains about your short fuse, or a patient’s family mentions your seeming lack of empathy for their situation—then it’s time to get help.
Compassion fatigue doesn’t just go away with a week off. You need to ask for help and be willing to devote some time to taking care of yourself. Seek out professional mental health counseling so you can vent your feelings without repercussions. Ask your supervisor or a close mentor for advice or for a temporary placement in a less stressful unit. At home, ask family or friends for a little extra support and opt out of the majority of your commitments, at least for a while. Remember, if you fell ill and couldn’t do these things, you wouldn’t. Compassion fatigue can take such a toll, that if you don’t address it, you risk putting your own health in serious danger.
If you think compassion fatigue rings a bell with your feelings, get help and take care of yourself. Every nurse knows this to be true: you can’t help other people until you help yourself.