As the nursing profession has evolved, the competencies to fulfill the role have expanded beyond the technical skills needed for acute care to include an understanding of the complex factors that influence health and well-being, organizational and systems leadership, evidence-based practice, and community and population health—competencies provided by a baccalaureate education. 

The University of Iowa College of Nursing’s RN-BSN program provides a pathway for registered nurses with an associate degree to gain this education and earn their baccalaureate degrees. Alyssa Wessel, RN, Brenda Duree, PhD, RN, and Kim Bergen-Jackson, PhD, RN-BC, LNHA are three nurses whose life paths have been influenced by their participation in the program. 

Five years ago, Alyssa Wessel graduated high school and began her path to higher education at a small private Iowa college. When that didn’t work out and she found herself back at home in Keokuk, Iowa, Alyssa knew she had to do something different. Following in her mother’s footsteps, she decided to pursue nursing. Wessel enrolled at Southeastern Community College in Keokuk, Iowa and began her journey as a nursing student. Today, Wessel is a staff nurse in the neonatal intensive care unit at University of Iowa Stead Family Children’s Hospital, working on her Bachelor of Science in Nursing (BSN) with dreams of earning her Doctor of Nursing Practice. 

In 1985, Brenda Duree embarked on a similar journey. As a young mom whose mother was a nurse’s aide, Duree grew up knowing the significance that nurses have in health care. She drove an hour each way to attend Iowa Lakes Community College in Emmetsburg, Iowa and earned her Associate Degree in Nursing (ADN). Duree is currently an associate professor in the University of Iowa College of Nursing RN-BSN program and has been a nurse, adjunct instructor, director of nursing, and associate dean at various institutions in Iowa throughout her career. 

Shortly after this, Kim Bergen-Jackson left home to attend Job Corps, a free education and job training program in Dennison, Iowa. They started a Licensed Practical Nursing program while she was there, so she decided to enroll. Bergen-Jackson is now administrator at Oaknoll Retirement Residence, adjunct professor in the UI School of Social Work and College of Nursing, Board of Directors Chair for LeadingAge Iowa, and was recently asked to serve on a national committee to enhance nursing home quality. 

History

Historically, there were three avenues to become a registered nurse: a hospital diploma program, a community college associate degree, or a college or university baccalaureate degree. In a 1965 position paper, the American Nurses Association noted that “major theoretical formulations, scientific discoveries, technological innovations, and the development of radical new treatments” were changing the practice of nursing, and they became one of the first public proponents of the baccalaureate degree as the minimum preparation for professional nursing practice.

Laura Dustan, College of Nursing Dean from 1964-1972, was the first to champion the idea of what would become the RN-BSN program at Iowa. She recognized that many nurses in the state lacked access to a baccalaureate program, and that registered nurses who later sought a baccalaureate degree had to first return to school for the required foundational courses.

Dustan led the development of articulation projects which aligned curriculums at accessible two- and four- year community institutions to allow for easy transfer to the University of Iowa or another baccalaureate program. The first cohort of seven students began in the summer of 1970, with that number growing to 20 in 1971.

Why the BSN?

The number of baccalaureate prepared nurses has grown over time as the knowledge and skills gained from the degree are increasingly recognized as necessary for a changing healthcare landscape.

In 1980, the diploma was the highest educational level of the majority of nurses, but that shifted in the 1990s as the diploma degree programs were closed. By 2000, approximately 67 percent of nurses reported the associate or baccalaureate degree as their highest level. In 2011, 50 percent of employed nurses held a baccalaureate degree or higher. 

In 2011, The Future of Nursing: Leading Change, Advancing Health was released by the Institute of Medicine, and recommended that the percentage of nurses holding a baccalaureate degree or higher be increased to 80 percent by 2020. The report gives several reasons for this goal, including that a BSN education will, “introduce students to a wider range of competencies in such arenas as health policy and health care financing, leadership, quality improvement, and systems thinking.” 

The “2020 National Nursing Workforce Survey” found that 65.2 percent of RNs were prepared at the baccalaureate level or higher. This was an increase from past years, but not the 80 percent recommended in the 2011 Future of Nursing report. According to the 2021 follow-up report, “The Future of Nursing 2020-2030 Charting a Path to Achieve Health Equity,” nurses already in the workforce "face barriers to pursuing a BSN, including time, money, [and] work–life balance.” The report continues, “Nonetheless, the goal of achieving a nursing workforce in which 80 percent of nurses hold a baccalaureate degree or higher remains relevant, and continuing efforts to increase the number of nurses with a BSN are needed. Across the globe, the proportion of BSN-educated nurses is correlated with better health outcomes.”

Finding the Path

Kim Bergen-Jackson worked as a licensed practical nurse in Seattle for many years before returning to Iowa and finishing her ADN at Kirkwood Community College. “There was a display—I’ll never forget—on the second floor at Kirkwood,” she said. “I walked out into the hallway after class and they were sitting at a table for the RN-BSN program and I was like, ‘hmmm,’ and I kept walking. The next day in a different class, the table was outside that room, and I was like, ‘maybe I should pay attention to this signal here.’” 

Bergen-Jackson entered the RN-BSN program after graduating from Kirkwood. The program was all online, which meant she could work full time and care for her two young children. “I worked full time as the director of nursing [at Oaknoll] and did my studies online and loved it. The convenience! I couldn’t have done it with the kids and work if it hadn’t been online. I did it at night after they went to bed, which prepped me really, really well for the PhD program.”

The opportunity to pursue her BSN arose in a similar manner for Alyssa Wessel. Wessel was considering what she wanted to do after earning her RN, when RN-BSN Program Coordinator Cheri Doggett came to campus in fall 2021 to conduct transcript reviews. “I had all of my classes, so it was like, okay, you should go here. You don’t have to take extra classes and it’s not far,” said Wessel. “My teachers really had a big part of that, because I really didn’t know where I wanted to go.” 

Wessel was drawn to the online aspect of the program, just as Bergen-Jackson was. Halfway through her nursing coursework, she became a new mom. Her family and friends helped her with childcare throughout her coursework and clinicals, but when she decided to continue her education, she knew she needed something that would accommodate a more flexible schedule.

For Brenda Duree, the path was a little different. While helping to teach a CPR class with local EMS and mentoring students in the emergency room, Duree discovered she really enjoyed teaching. She always knew she wanted to obtain her bachelor’s degree and, after her children were older, she decided to enroll in the RN-BSN program to earn her degree and begin to teach. Today, as a professor in the program, Duree says, “I can very much relate to the students because many of them are like I was, and they’re trying to balance work and school and families.”

The hidden gem

The RN-BSN program remains an important part of the College of Nursing’s efforts to develop a baccalaureate prepared nurse workforce in Iowa. “The thing that I think is really fantastic about this little hidden gem of a program,” said Program Coordinator Cheri Doggett, is that, “it’s all online, we’re flexible with the three plans of study, and it’s really good for rural health care in Iowa, which is what Iowa needs.”

Associate Dean for Undergraduate Programs Anita Nicholson PhD, RN agrees. “It’s our RN-BSN program that has the biggest impact on the state,” she said. “If those nurses go back to get their baccalaureate degree, they’re set on staying in that part of the state. So having that additional nursing knowledge really benefits that community.” 

The College of Nursing currently has RN-BSN 3+1 articulation agreements with ten community colleges around the state. These agreements align the curriculum between the institutions, so it is a seamless transition from the associate degree to the bachelor’s degree. 

This made a significant difference for Bergen-Jackson. She had her transcript evaluated and was pleased that the majority of her course credits transferred. “It was easy. It was organized. It was well constructed. It just felt like a breeze to me,” she said, adding, “if it hadn’t been so organized, I would have never in a million years applied to the PhD program.”

Students enrolled in the RN-BSN program take four professional role classes focusing on research, patient safety, improving health care systems, leadership, and professional engagement in addition to a pathology course, genetics course, nursing elective, community and public health nursing class and practicum, and a baccalaureate seminar. The program offers three plans of study (three, four, or five semesters) students can choose from to accommodate their schedule and work or family responsibilities. 

Those professional role courses “really are the beauty of that baccalaureate education,” said Nicholson. The content for those courses was developed based upon the American Association of Colleges of Nursing Essentials: Core Competencies for Professional Nursing Education and anticipating the needs of future nurse leaders. “That’s how we’ve packaged our content in order for our students to get that important information that really makes them leaders out in the practice world,” said Nicholson.

Brenda Duree sees the impact of this content in her baccalaureate seminar, the final course RN-BSN students take. “We state [the AACN] competencies, and then we say, ‘tell us, throughout the program, how you have met those,’” she said. “Their stories are so heartwarming, because at the RN-BSN level, they’ve worked now as a nurse, and they really get it. I just see such a transformation, because you move beyond what it’s like to be a nurse, the tasks that you do daily, and you look more holistically at nursing. What I say oftentimes is that it I think it takes you back to what the purpose of nursing is.”

Alyssa Wessel has already noticed the difference in her classes. “I really feel like what I’m learning is unlocking a different perspective that’s going to help me really encompass every aspect of care for my patients,” she said. “Whether that is their background, maybe their ethnicity, their culture…. It’s not really something that we learn a lot about at the ADN level, because they’re so focused on the skills, the disease processes, and stuff like that.”

Opening doors

What nurses choose to do after earning their BSN through the RN-BSN program varies, but the opportunities that come with the BSN degree from the University of Iowa are many. 

For Kim Bergen-Jackson, it was a stepping stone to the PhD program. “I never would have said I could get a PhD. Never,” she said. “I remember being interviewed for the PhD program and I just wanted to cry I was so nervous.” Bergen-Jackson also recognizes that many of her accomplishments, such as being asked to serve on a national committee to enhance nursing home quality, wouldn’t have been possible without the program. “The RN-BSN program started it all because people would not know who I am, because I wouldn’t be in a position to be doing work that would catch the attention of somebody at the national level,” she said.

For Brenda Duree, the RN-BSN program opened the door to a career in teaching, which she loves. She recalls that when she joined the college faculty in 2018, “it was just the coolest thing to come back. I sat there as an RN-BSN student, scared and intimidated, and then to be able to come back as a faculty member—I was just so thankful. I was like, ‘wow, you kind of made it.’” 

Duree loves working with the nurses who are her RN-BSN students and helping them broaden their nursing scope. “At the end of the day that’s what I feel like my job is,” she said. “Just trying to better help them and give them tools to love their profession and to make a difference.” 

As it did for Duree and Bergen-Jackson, the program has opened the door for Alyssa Wessel to a new path she never envisioned. “I actually never had thought about going to the University of Iowa, it kind of just fell in my lap,” she said. “I’m just so happy it did because now I’m looking at the BSN to DNP programs. Now that I’m here I’m like, why stop? Why settle?” 

“The program definitely gives people who didn’t take the traditional route [access to] the opportunities that are still out there," Wessel added. “I really liked that about the program—there are people from all different age ranges. It’s just nice to know that there are opportunities out there for people of all ages to continue their education. Even if it’s years after they started.”

► Read more from the 2022 College of Nursing Magazine