This Time, I Choose Nursing

I have often said that, had I been smarter, when I returned to university the last time (or perhaps even one of the times before that), I would have studied nursing.

Had I pursued that path, I would be one of an increasing number of people who are graduates of second-degree nursing programs. According to an American Association of Colleges of Nursing fact sheet updated in June 2008, in the United States in 1990, there were 31 accelerated BSN programs and 12 accelerated MSN programs offered. Today, there are 205 accelerated BSN programs and the 56 accelerated Master's programs, with 37 new accelerated BSN programs and 13 Master's programs in the planning stages.

Why the explosion in programs? According to Deborah Raines, PhD, RNC, who is a professor at Florida Atlantic University's Christine E. Lynn College of Nursing, and who has done research on the second-degree nursing student, the major reason is the demand for nurses. "If a school can offer a one-year accelerated, second-degree program and a two-year traditional program, and each program can take 80 students, in two years, the accelerated program with have 160 nursing graduates while the traditional program will have 80." And those 160 will have more than one degree under their belts.

Who Are Second-Degree Nurses?

Raines has observed that second-degree nurses typically fall into one of two groups: about half are the 'economic refugees' – those who were downsized or outsourced from other professions, and who choose nursing with the idea that they can always get a job; the second half are those who "have a calling" – those who have always wanted to be a nurse, or those who became involved with the care of a sick friend or relative, and decided that they want to make a difference in a similar area, such as hospice or pediatrics.

Second-degree nurses tend to be highly motivated and driven, and they typically come with high GPAs – and sometimes advanced degrees. Most have been out of school for about five years before they return, and they typically have been very successful in their first career. "These are not entry-level people," Raines explains, "These are people who have moved up the career ladder." A small number, she says, don't fit this mold: Some come with "pitiful GPAs" from their initial degree, but are now older, wiser, have families, and write heart-wrenching letters about how they messed up the first time, know better now, and really want to make a difference. Occasionally the programs make exceptions for these applicants, and typically they do excel the second time around.

There are also more men in second-degree programs than in initial-degree programs. At Florida Atlantic University, for example, about 20% of students in the second-degree program are male versus 5-10% in the initial degree program.

Can You Really Train an RN in One Year?

Yes, says Raines. "These people are driven. They want information and they want to learn. The do not want fluff and busy work. They can read, they can research, and they can take the test."

But beyond the books, nursing is hands-on, so the key, she says, is in how you handle the practice courses, to teach these students professional judgment and critical thinking as quickly as possible. She gives the example of the system in use in her school's program, which has been very successful. The students stay at one hospital for the entire year of the program. Not only does this save time that may be lost with additional orientations, but the student gets to know the facility and the staff, and one nurse is able to work with the student for the whole year. Students in the program also attend practical placements for two consecutive days each week, accompanying their nursing instructor during a 12-hour and an eight-hour shift, so they are able to see continuity of care, which may be lost when practical training only occurs once each week, and there is pressure to move patients out of the hospital as quickly as possible.

The Benefits of Second-Degree Nurses

Raines says that the DONs she speaks with love hiring the graduates from accelerated second-degree nursing programs. They are very smart, educated, and driven. They typically ask more questions and get more involved than other new graduates. They are also typically more mature and career-focused, and understand what it means to hold a job and be in the workforce.

Another benefit of the second-degree nurses is that they bring an outside perspective to their work, which those educated solely in nursing usually lack. Raines gives an example of a student whose background was in advertising and marketing, and who developed patient education materials in the same way that she would develop materials for an advertising client. "She made them more attractive, and more likely to be read," Raines says, "Her philosophy was, 'Now that we've got your attention, we'll teach you something.' They were totally different from the types of materials that those whose education had been solely in nursing have created." And there was the second-degree nurse whose background had been in literature, and who was working in hospice. She very successfully incorporated literature and poetry into the care of patients and families.

Perhaps the other benefit is the simple fact that these nurses are highly educated. A landmark study entitled Educational Levels of Hospital Nurses and Surgical Patient Mortality, which was published in the September 24, 2003 issue of The Journal of the American Medical Association, found that a 10% increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5%. Further studies have confirmed the 2003 study's findings.

The Challenges of Second-Degree Nurses

There two types of challenges – those faced by the second-degree nurses and those faced by people who educate and who work with second-degree nurses.

Of the former, the main challenge is navigating the change from being a leader, manager, or expert in one's former field, to being a novice in the new one. "Even during clinicals," Raines says, "We remind them: 'You must know how to practice before you can lead. You're not running the floor. You're going to need to ask for help. You won't give answers, you'll seek answers."

And in seeking answers, often they question the way things are done on units. So to help these nurses, one assignment given is to find something that is done on their unit that they find illogical, then go to the literature to find out why that "illogical" thing is done as it is – What are the benefits? What are the risks? Is it useful or wasteful?

Acceptance can be another challenge, in that sometimes more experienced nurses have a problem relating to the second-degree nurses. Some established nurses have a different perspective – "I do it this way, because that's how I was taught" – and they resist or feel threatened by the nurses asking "too many" questions and challenging the status quo. And they, like many, feel threatened when asked questions for which they don't know the answer.

Of course, it's not just staff nurses who are faced with tough questions from the second-degree nurses: Sometimes even Raines and her academic colleagues are sent to the literature when the students ask a particularly detailed, obscure, or technical question. Frustrating? Intimidating? Perhaps, but in the end, this challenge is also a benefit, for as Raines says, "It moves all of us to a higher level of preparedness."

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