- The nursing profession has long sought more diversity in registered nurses (RNs) to reflect the populations served. One way to enhance RN diversity is through diversity in community college (CC) associate degree in nursing (ADN) programs.
Since ADN programs lead to professional employment with middle-class wages, they form an important social equity opportunity for students from disadvantaged or underrepresented backgrounds. However, even in the face of a widely reported national RN shortage, ADN programs are often oversubscribed, and not all qualified applicants can be admitted. That oversubscription of ADN programs leads to the question of who is admitted.
There is evidence in the literature review of the study and in the study’s results that post-baccalaureate reverse transfer students (PRTSs)—students with bachelor degrees who attend CCs—displace other students in ADN programs. That suggests that CCs may be providing, however unintentionally and unknowingly, a second opportunity for PRTSs at the expense of a first opportunity for other, perhaps more diverse, students. That would call into question the egalitarian CC ideal of open access. PRTSs thus present questions of access, diversity, and social equity not just for ADN programs, but for other programs of study and for the nursing profession.
In support of this study, the Washington State Board for Community and Technical Colleges (WA-SBCTC) provided 36,356 depersonalized student records from the 27 Washington CCs with ADN programs. The student records were from five academic years: 2001-2002, 2005-2006, 2006-2007, 2009-2010, and 2010-2011.
The data allowed comparisons of students by prior education level (PRTS or non-PRTS) who were considered to be seeking ADN admission compared to those enrolled in ADN programs. The study design was quantitative and exploratory, with some qualitative elements. Since the quantitative data were all categorical, chi-square tests of independence and log-linear analysis were used to check for associations between variables. Those variables were prior education, ADN enrollment status, age group, race/ethnicity, socioeconomic status (SES), and sex.
Qualitative information came from consultations with three Washington colleges’ ADN program managers. The colleges were recommended by the WA-SBCTC due to their nursing education leadership roles in the state. The ADN managers were interviewed at two points in time: 2008 and again in 2016.
In the quantitative analysis, chi-square tests showed PRTSs to be significantly associated with gaining ADN enrollment in disproportion to other students. PRTSs became increasingly prevalent as a percentage of enrolled ADN students over time in the study’s data, even as the state’s ADN enrollment volume increased. In the first year of the study (2001-2002), PRTSs amounted to a little under one in 10 of the 1,585 ADN students statewide. By the last year of the study’s data (2010-2011), the percentage of PRTSs had roughly doubled, approaching nearly one in five of the 2,660 ADN students in Washington CCs.
PRTS demographics were markedly different from non-PRTSs. PRTSs were significantly more likely than non-PRTSs to be older (30 and up and even more so 40 and up); Asian/Pacific Islander; high SES as defined in the study; or male.
The study also found statistically significant evidence that White/Non-Hispanic students disproportionately gained admission to ADN programs regardless of PRTS status.
Qualitative consultations with ADN program managers did not reveal a perceived PRTS advantage in gaining ADN admission. This stood in contrast to the quantitative analysis. Possible reasons for the apparent discrepancy are discussed in the study. The ADN program managers did, however, see PRTSs as having strengths such as experience, organizational skills, life-school balance, and academic capability.
In the qualitative consultations, ADN managers affirmed the value of diversity. However, they held diversity to be a secondary priority to student ability to succeed in the ADN program and in the nursing profession. More important than the racial or ethnic identity of a nurse was nurse competency and nurse ability to transcend cultures, according to interviewees.
The study concluded that PRTSs disproportionately consumed limited ADN enrollment space, thus evidently displacing non-PRTSs and that their demographics were significantly different than those of non-PRTSs. The study further found that ADN managers held that the top priority for ADN admission was ability to succeed in the ADN program and subsequently in the nursing profession. That prioritization was driven by required NCLEX pass rates, accreditation, fairness to students, the interests of the nursing profession and patients, college completion rate goals, and the ability of students to attain further nursing degrees after the ADN.
The presence of PRTSs in ADN programs brings CCs face to face with practice and policy implications. On the one hand, PRTSs may help ADN programs achieve graduation, accreditation, and continuing education goals. On the other hand, PRTSs consume limited ADN space at the expense of non-PRTSs who may thus be blocked, or at least delayed, from entering a program of study that provides access to a middle-class income. ADN programs may serve as a bellwether for other college programs of study, pointing to the need to prioritize student success over objectives of diversity, social equity, and open access as they are currently put into practice, while establishing new and more effective policies and strategies for meeting those social objectives in a new paradigm that supersedes the increasingly strained concept of open access.