As we work on implementing the APIN grant, we would like to know what the current barriers are for ADNs starting a RN-to-BSN program? Do you have any peers who should be going back to school but aren't - what are their hurdles?

Thanks so much for a great question. The best source of information around this question was recently published. The citation and abstract are given below. The website for the RN Work Project http://rnworkproject.org directed by Christine Kovner also has valuable information to add. CHARTING THE COURSE FOR NURSES' ACHIEVEMENT OF HIGHER EDUCATION LEVELS CHRISTINE T. KOVNER, PHD, RN, FAAN, CAROL BREWER, PHD, RN, FAAN, CARINA KATIGBAK, MS, APRN-BC, MAJA DJUKIC, PHD, RN,§ AND FARIDA FATEHI, MS To improve patient outcomes and meet the challenges of the U.S. health care system, the Institute of Medicine recommends higher educational attainment for the nursing workforce. Characteristics of registered nurses (RNs) who pursue additional education are poorly understood, and this information is critical to planning long-term strategies for U.S. nursing education. To identify factors predicting enrollment and completion of an additional degree among those with an associate or bachelor's as their pre-RN licensure degree, we performed logistic regression analysis on data from an ongoing nationally representative panel study following the career trajectories of newly licensed RNs. For associate degree RNs, predictors of obtaining a bachelor's degree are the following: being Black, living in a rural area, nonnursing work experience, higher positive affectivity, higher work motivation, working in the intensive care unit, and working the day shift. For bachelor's RNs, predictors of completing a master's degree are the following: being Black, nonnursing work experience, holding more than one job, working the day shift, working voluntary overtime, lower intent to stay at current employer, and higher work motivation. Mobilizing the nurse workforce toward higher education requires integrated efforts from policy makers, philanthropists, employers, and educators to mitigate the barriers to continuing education. (Index words: Continuing education; Bachelor's; Degree; Master's; Nurses; Nursing) J Prof Nurs 28:333–343, 2012. © 2012 Elsevier Inc. All rights reserved.

I think it is also worthwhile to reflect on the disincentives so that we can better address these concerns. Orsolini-Hain (2008) found several things that contributed to nurses being less inclined to advance their education. These included the lack of distinction between nurses with a higher degree at the bedside and an inability to appreciate how an advanced degree would affect their practice, as well as others. These concerns are being addressed by many of our executive nursing colleagues through hiring and promotion preferences, career ladders, professional practice councils and other incentives. Here is a link to the abstract: http://sunzi.lib.hku.hk/ER/detail/hkul/4335557

I heard Dr. Orsolini-Hain present this information at the N-OADN convention last November - very interesting. She also said that hospitals are doing such a great job of meeting the nurse's educational needs through "just in time" learning - so that is another disincentive. The economy is providing an incentive currently with the lack of hiring ADNs where the graduates want to work, but when the economy gets better I am afraid the patterns will revert back to low numbers continuing on. Therefore we need to get plans and processes in place to get the nursing students in a mindset from day one in nursing school that they will go on, that getting the BSN will be the expectatoin. In Texas we are trying to standardize the general education courses so that they can take the courses before they start the ADN nursing courses and will be ready to go to any of a number of universities when they graduate and pass their NCLEX and start their RN-to-BSN nursing courses. Until we can do this, the numbers won't stay up.

I agree, Helen; it is frustrating to recognize the extent to which we are driven by market forces. OTOH, as you mention, we have a great window of opportunity now! In some areas of the country, I am seeing a tipping point of the sort you mention; students enter an AD program with the intent all along that they will proceed to the BSN, so when we can provide a straightforward path we make their journey much easier. There is much wider variability in the support offered by employers and practice partners.

To answer your question-Many ADNs choose not to return to school for their BSN as there are no financial rewards to return to school, only further financial burdens. ADN wages are the same in most facilities as BSN wages.