- Contact the Committee

Good morning Mr. Chairman and members of the Subcommittee. I am Dr. Andrea Mengel, director of Nursing at the Community College of Philadelphia in Philadelphia, PA. Thank you for the opportunity to address the Subcommittee about nursing recruitment and retention at the Veterans’ Health Administration (VHA) and to present recommendations for strengthening the VHA nursing workforce from the American Association of Community Colleges (AACC). AACC represents 1,173 community colleges, which enroll 10.4 million students—44 percent of all U.S. undergraduates. Community colleges are committed to educating quality nurses and to enhancing the capacity of nursing education programs to address the nursing shortage. Half of the nation’s registered nurses (RNs) and 70 percent of its licensed practical nurses (LPNs) are educated in community colleges.
Mr. Chairman, for more than 50 years, community colleges have provided the nation with RNs who take and pass at the same rate as do RNs with bachelor’s degrees the licensure exam that all nursing graduates must pass to practice nursing. Throughout the nation, RNs who earned their degrees at community colleges are sharing the same responsibilities as they practice alongside their counterparts from bachelor’s degree programs. Mr. Chairman, an RN is an RN. A bachelor’s degree in nursing does not educate or authorize RNs to provide additional care to patients. Not a single state in the nation requires RNs to obtain bachelor’s degrees to practice or advance within their careers. The Health Resources and Services Administration (HRSA) reports that 62 percent of employed staff nurses, including 45 percent in nurse clinician positions, 42 percent in clinical nurse specialist positions, 52 percent in head nurse positions and 65 percent in nurse supervisor positions, received their nursing educational preparation through associate degree or diploma nursing programs.
Additionally, HRSA reports that 15.6% of AD graduates hold a previous associate, bachelor’s or master’s degree. Many AD students pursue nursing as a second career. Further, community college graduates represent a large percentage of nurses of color in the profession, and bring a breadth of experience and dedication to the field of nursing. Associate degree nursing programs allow students to move into the workplace more quickly and at a lower cost. According to the U.S. Dept. of Education, on average students pay $1,379 per year in tuition at public community colleges—the majority of two-year colleges—compared to $3,746 per year in tuition at public four-year institutions. Through the National Nurse Education Initiative, the VHA is spending an average of $11,000 to educate an RN to the bachelor’s level. This same funding could educate 3.9 RNs in associate degree programs, thereby providing a workforce of very high quality relatively quickly.

Nationwide, health care providers and patients alike value the care provided by RNs educated in community colleges. Surveys of RN employers and of patients themselves have shown no preference for RNs educated in one type of program over another. Data from a recent AACC survey indicate that hospitals and other facilities across the country are collaborating with most community colleges to enable them to expand enrollments in and increase graduations from nursing programs. These health care providers regard RNs receiving their education in associate degree programs so highly that most require those students to agree to serve at their facilities upon graduation in exchange for scholarships and many provide their own nurses—desperately needed to meet patient demands—to community colleges to enable the education of more RNs.
As a lifelong nursing educator, I am very disappointed in the hiring and promotion policy instituted nationwide by the Department of Veterans’ Affairs. It is very disappointing that the VHA’s hiring and salary progression policies do not value RNs practicing with the associate degree. The VHA’s Nurse Qualification Standard is a disincentive to work at the VHA to 60 percent of new RNs as well as to hundreds of thousands of experienced RNs educated in associate degree programs. These RNs, who have achieved licensure exam passage rates equal to those of their bachelor’s degree counterparts and have proven to provide quality patient care that cannot be differentiated from that provided by RNs with bachelor’s degrees, cannot advance within the nursing profession at the VHA after years of experience as a registered nurse.
Nursing practice outside of the VHA is a better career choice for the well educated, quality, and often experienced nurses who earned their degrees at community colleges. With hundreds of choices of workplace opportunities, why would new RN graduates from associate degree programs choose to work at the VHA where the hiring and promotion policy will hold them back? Community colleges across the nation report that their graduates are not choosing the VHA. For example, not one of 300 RNs graduating from Community College of Philadelphia in the past four years chose a position at the VHA, and in 2002–2003, Delgado Community College in New Orleans reported a graduation of approximately 400 RNs of whom not one chose the VHA as a workplace. Until 1994, Portland Community College placed many nursing students at the local VA hospital for clinical experiences, but ceased to do so because of the initiation of educationally discriminating hiring practices. AACC believes that for almost a decade Portland Community College graduates have not sought employment at local VA hospitals because of this policy change. The VHA is losing an invaluable opportunity to recruit nurses from Community College of Philadelphia and over 700 additional community colleges as well as from hundreds of facilities that value community college graduates. Why should experienced RNs leave environments where they are appreciated and rewarded to work in a system that discriminates against them? These RNs—new and experienced—are excellent, dedicated professionals who wish to provide patient-side care as well as to advance in their careers.
Mr. Chairman, AACC and the Community College of Philadelphia support higher and continuing education opportunities for all nurses in an inclusive model that promotes articulation of the nursing student at all levels. We know that the majority of RNs earn associate degrees. In addition, we know that:
• The NCLEX-RN examination pass rate for RNs with associate degrees in nursing is equal to the pass rate for RNs with bachelor’s degrees in nursing.
• The number of minority students receiving associate degrees in nursing is increasing.
• Community colleges educate the majority of nurses practicing in rural and long-term care settings.
• RNs educated by community colleges are more likely to stay in their communities to practice nursing.
• Community colleges offer the most cost effective, efficient, and accessible nursing education programs.
• RNs with associate degrees represent more than one quarter of students enrolled in bachelor’s nursing programs.
• The VHA’s current policies are based on the unvalidated premise that more formal education automatically equates to better performance.

To continue to provide high quality nursing care for patients, AACC recommends that the VHA adopt the following hiring and promotion strategies:

• Employ all new RNs entering nursing at the same level.
• Provide promotion opportunities for all RNs based on performance and continuing education in specialty and master’s degree programs.
• Support continuing education for all RNs.
• Encourage experienced RNs to work for the VHA.
• Utilizing the National Nurse Education Initiative funding, implement a RN to MSN program to address the nursing faculty shortage. (Expand enrollments of RNs with associate degrees in the nation’s more than 150 graduate nursing programs that enroll RNs without requiring bachelor’s degrees in nursing.)
• Create and fund a program to provide opportunities for RNs planning to retire from the VHA to enroll in master’s degree programs that will enable them to serve as faculty. (A shortage of faculty is preventing nursing programs from expanding enrollments to meet the nation’s need for nurses.)

Mr. Chairman, the threats to the stability of our nation’s health care system and the safety of patients posed by the nursing shortage are reported almost daily. Community colleges echo these concerns as nationwide hospitals, long-term care facilities, and others care for our sick, elderly, and disabled with inadequate numbers of nurses. Federal projections indicate a worsening nursing shortage. The Bureau of Labor Statistics projects a need for 1.1 million new and replacement RNs by 2012 and an additional 1.2 million nursing aides, home health aides, and similar health care workers between 2000-2010. A recent HRSA report on workforce trends predicts the percentage of time spent treating elderly and minority patients will increase significantly in coming years.

Mr. Chairman, the nation’s health care system recognizes the value of RNs with associate degrees and employs and promotes them along side their bachelor’s degree counterparts. AACC encourages the VHA to do the same. RNs from associate degree programs would welcome the opportunity to care to for our veterans.
Thank you for the opportunity to speak to you today. I welcome any questions.