At an increasing rate, nurses with associate degrees are returning to postsecondary institutions to complete their bachelor's degrees. The external forces and personal motivations driving associate degree-holding RNs to pursue a BSN are not fully understood and require further exploration to guide both policy and program development. Currently, 679 RN to BSN programs in the United States are providing educational opportunities to help meet the increasing demand for higher education at the baccalaureate level (American Association of Colleges of Nursing's [AACN], 2015b).

Data from the AACN's (2015b) fall 2014 survey of baccalaureate programs reported that these 679 programs, of which more than 400 are at least partially online, represent a 10.4 percent increase in program growth from the prior 2013 year. In terms of overall number of graduates from RN to BSN programs, the AACN reports that RN to BSN graduates doubled from 2011 to 2014, with 49,777 nurses earning BSN degrees in 2014. The most current enrollment numbers reported for 2013 to 2014 indicate that 130,045 RNs were enrolled in RN to BSN programs, with 28 new programs under development (AACN, 2015a). This reported growth in RN to BSN programs suggests a particular demand for BSN degrees for nurses holding an associate degree in nursing. Literature suggests that both employer requirements and intrinsic motivational factors are contributing to the demand for higher education at the baccalaureate level (AACN, 2015a; Altman, 2012).

Policy initiatives such as those set forth by the Institute of Medicine call for 80 percent of the nursing workforce to hold a bachelor's degree by 2020 (Institute of Medicine, 2011). In 2013, the National Council of State Boards of Nursing estimated that 61 percent of nurses held a baccalaureate degree or higher (AACN, 2015b). The Institute of Medicine argues that this approximately 31 percent increase in bachelor's-prepared nurses is necessary to improve the overall quality of care in the United States, particularly care provided in hospitals at the bedside. RN to BSN programs are one pathway for achieving this goal. It is unclear, however, whether nurses who complete RN to BSN degree programs intend to return to the acute care bedside.

Critics have questioned whether "drawing nurses back to school contributes to the nursing (BSN) shortage" at the bedside and hence compromises the ability to improve overall quality of care at acute care institutions (Robert Wood Johnson Foundation, 2013, p. 2). Nurses obtaining a BSN degree open many doors of opportunity for themselves, and they may be seeking completion of their BSN degree with the intention of pursuing a career path away from the acute care bedside. However, other experts suggest that RN to BSN graduates will remain at the bedside. A recent study conducted by Auerbach, Beurhaus, and Staiger (2015) concluded that the number of BSN-prepared nurses in acute care hospitals is increasing. Other data found that BSN and ADN nurses remained in direct care positions for six years after obtaining their degree (Robert Wood Johnson Foundation, 2013).

Although there is little debate that increasing the overall educational level of nursing professionals is important for a number of reasons across the care continuum, the open question is whether associate degree RNs are seeking attainment of a bachelor's degree through RN to BSN completion programs with the intention of remaining at the bedside. A literature review conducted by Altman (2012) found that a small number of studies suggested personal achievement or satisfaction, career advancement, improved clinical judgment, and increased knowledge were reasons RNs were returning to higher education to complete their bachelor's degree.

With the limited research in this area, the following study sought to expand understanding of the motivation and future goals of RN to BSN degree completion students. In addition, the study aimed to identify whether RNs returning to an online RN to BSN completion program were doing so specifically with the intention of continuing to practice nursing at the bedside in the acute care setting.

METHOD

Setting and Sample

This qualitative study involved discourse analysis using secondary documents for both a textual and contextual perspective on RN to BSN motivational patterns. Data were collected on students enrolled in an online RN to BSN completion program at a single site public university in New York State. Approval from the university institutional review board enabled the sampling of Educational Planning essays written by students in the RN to BSN completion program between the years 2008 and 2013. Every student who enters the RN to BSN program at this particular research site is required to write the Educational Planning essay.

One of the primary functions of the essay is to serve as a means for students to articulate the reasons they are choosing to pursue a baccalaureate degree and their personal career goals. A random sampling of the student essays (n = 254) submitted to the college during this time period was selected for the purposes of identifying demographic information as well as motivational and career goal factors associated with the decision to return to complete a baccalaureate degree. This sample size of 254 represented 30 percent of the total student population that enrolled during the years 2008-2013. Educational Planning essays at this public university are typically written in the first term of the RN to BSN program.

Data Collection and Coding

In vivo or verbatim coding and discourse analysis of student essays were conducted using Atlas.ti, a qualitative data analysis and research software program (Friese, 2012, Saldana, 2009). Prior to uploading student essays into Atlas.ti, the essays were extracted from an online course management system, transferred into Excel where they were randomly sorted, and then assigned a unique identifier code containing demographic information. The identifier code included information on gender, ethnicity, age, and the number of years since graduating from an associate degree nursing program.

In vivo coding of student essays was used to create codes from direct student content looking at why students were returning to college to complete their BSN and their future career goals. Twenty in vivo codes were created during this primary coding process. The codes were further collapsed into 15 thematic pattern codes for the purpose of analysis of the key reasons students were motivated to enroll in the RN to BSN completion program (Saldana, 2009).

Data Analysis

A social constructivism approach was used to analyze the data collected in this study (Creswell, 2009). Using Atlas.ti, occurrence and co-occurrence of codes were analyzed to examine the social phenomena and decision-making patterns of RNs with associate degrees who are returning to the RN to BSN degree completion program. Cross-tabulation of the demographic codes and the thematic codes derived from the in vivo codes was conducted to identify predominant patterns and themes found in the student essays. This qualitative analysis process enabled the researcher to examine and interpret the motivational patterns of a cohort of students in their decision process to enroll in a RN to BSN completion program.

RESULTS

Findings from this single-site study at a public university in New York State suggest that a number of students enrolling in the RN to BSN completion program are doing so with the intent to pursue a career in nursing away from the inpatient hospital bedside. Of the 254 student essays examined in this study, 182 or 72 percent of the students indicated that they were returning to complete their baccalaureate degree for one of five primary reasons. The completion of the BSN degree was noted as a pathway for either entry into 1) a nurse practitioner program, 2) a master's degree program in general, 3) promotional opportunities in management positions, 4) nurse educator roles, or 5) leadership positions in general. Other less prevalent responses recorded from the essays included lifelong learning, valuing a BSN degree, Magnet requirement, advisement from an associate degree program faculty member, and desire to practice in an acute care setting.

Other demographic findings emerging form the study identified that 90 percent of the essays were written by women and 74 percent of the sampled population self-selected as white/Caucasian. These findings were representative of the entire population of students who enrolled in the online RN to BSN program at this public university. The age distribution ranged from 25 to 60 years. In each of the five-year age groups, there were on average 30 to 40 students represented, with the exception of the 55- to 59-year age group, which had only 17 students. In addition, roughly half, or 51 percent, of students enrolled in the RN to BSN completion program within 5 years of completing their associate degree; 70 percent began the RN to BSN completion program within 10 years of completing their degree.

DISCUSSION

This study illuminates the intentions and goals of nurses enrolled in a RN to BSN online completion program. The findings challenge the assumption that associate degree nurses seeking their bachelor's degree are doing so with the intention of returning to or remaining at the bedside in acute care settings. Analysis of data suggests that the majority of nurses in the study are returning to higher education to complete their BSN degrees as a bridge to graduate school to obtain either a management or nurse practitioner role and not with the intention of remaining at the bedside in an acute care setting. With so many of the RN to BSN degree completion students expressing a desire to continue on to graduate school, there may be an unrealized and growing opportunity to reduce the shortage of nursing faculty and an opportunity to increase the number of advanced nursing health care providers in the primary care setting. However, in the same vein, if a significant number of RN to BSN degree nurses pursue advanced practice roles away from the acute care bedside and there remains unmet demand for BSN nurses practicing there, then providing quality of care and improved patient outcomes could continue to be a challenge in the acute care setting.

CONCLUSION

Whereas this study identified the intended goals and intentions of nurses who are enrolling in the RN to BSN completion program, it does not indicate whether nurses are actually staying at the bedside or are moving into, for example, a management or advanced practice role upon completion of their BSN degrees. Educational pathways have expanded through a variety of policy efforts to support the growth of a more highly educated nursing workforce. The goal of these efforts is in part focused on increasing the number of nurses with BSN degrees.

The potential unintended effect of these educational pathways and policy initiatives is that a greater percentage of graduate level-prepared nurses will emerge, without an increase in BSN nurses practicing at the bedside. Questions still remain. Gathering data from graduates of the RN to BSN program one to two years following completion of the program would enable a more complete understanding of where these nurses end up working along the continuum of patient care. In addition, further research beyond the single research site and additional labor market analysis of advanced practice nursing needs would further illuminate understanding of the phenomenon.

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