Choosing a Nursing School or Program

Dr. Barbara Grumet is currently the Executive Director of The National League for Nursing Accrediting Commission (NLNAC), which is responsible for the accreditation of post-secondary and higher degree nursing education schools and programs, including practical nursing, associate degree, baccalaureate, masters and doctoral programs.

Dr. Grumet holds a Doctor of Jurisprudence from New York University School of Law. Although trained as a lawyer, she has spent her entire career in higher education as a professor and an administrator. Her academic disciplines are health care law, ethics, and health services administration. Dr. Grumet came to NLNAC in July, 2001, and before that was an Associate Provost at Long Island University, responsible for one of their branch campuses. For the previous 18 years she was a faculty member and Graduate Dean at The Sage Colleges in Troy and Albany, New York, where she taught graduate students in health services administration and nursing. She also had an adjunct faculty appointment at Albany Medical College, where she taught health care law and ethics to graduate nursing students, psychiatry residents, and medical students.

Dr. Grumet's Career |  Nursing Accredidation Education |  Nursing Education |  Other Questions

DR. GRUMET'S CAREER

How have you defined career success for yourself? What have been your personal key(s) to success?

I have defined success for myself in very personal ways. I want to have an impact on my students. I want them to feel that I challenged, informed, and even inspired them. It is very exciting and gratifying to me to see “light bulbs go off” when students grasp a complex idea and begin to make connections between the classroom and their own professional lives. Most of my students have been adults, as opposed to traditional age college students, with significant professional and life experience. I learned as much from them as hopefully they learned from me.

I was privileged to have the opportunity to serve on a number of health care governing boards while I was in Albany. It was a great way to give back to the community, as well as learn what was going on first hand in health care.

I don't think I have reached the “final success” in my career. My current job is a great combination of all I have been doing professionally over the past 25 years – combining education, administration, and governance.

What would you consider your proudest accomplishments in the field? Have you had any major setbacks along the road?

I am proud of the changes I implemented at Sage while I was Graduate Dean. We began a research symposium, which is unusual for a master's level institution, that allowed students from 14 different Master's degree programs to come together to share the research they were doing in their programs.

Here at NLNAC we are streamlining the process, to make sure that our programs get the best possible value for their dollars. I am proud of the work I have done with the Commissioners, as they become stronger and more involved with the Commission as a corporation, as well as the important work of accrediting nursing programs.

What do you enjoy most about your job, your career?

What I enjoy most is getting to know the nurse administrators and nurse educators who are working so hard to educate the next generation of health care professionals. I also enjoy working with the Commissioners and other leaders in education from around the country.

What is a typical day of work for you entail? What are your key responsibilities?

My most important responsibility is to oversee the accreditation of 1500 of the nation's nursing education programs – Master's, Baccalaureate, Associate, Diploma, and Practical Nursing. A typical day includes working with the staff here at NLNAC on the day to day operations of the Commission, communicating with Commissioners, nurse educators, regulators, and higher education administrators and executives from around the country. I also talk with students who have questions about nursing as a career or are having problems with a particular nursing school. I do a lot of traveling around the country, working with our schools, attending meetings, etc.

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NURSING ACCREDIDATION

Can you please provide a history of Nursing Accreditation including important people and organizations?

Nursing accreditation began in the early 20th century when the organization that is now the National League for Nursing began to establish standards for the education of nurses. This activity evolved into accreditation as we know it today – a voluntary, peer-driven, nongovernmental activity dedicated to improving quality. In 1952 the National League for Nursing was one of the first organizations to be “recognized” by the federal government as an accrediting body. NLNAC was created as an independent unit of NLN in 1997 and became a corporation in 2001. Editors Note: The NLNAC Accreditation Manual has a section on the history of accreditation.

Please tell us about the future of Nursing Accreditation - what are important trends and changes you see ahead?

I see several changes ahead. First, when accreditation was started, we were the only game in town. Now there are government agencies, such as state boards of nursing, state departments of higher education, that also review quality of nursing education programs. Second, as higher education gets more expensive, people are questioning the costs and the “need “ for accreditation. In addition, there is competition within nursing itself for accreditation . The Commission on Collegiate Nursing Education (CCNE) also accredits Bachelors and Masters programs. Other groups look at nurse practitioner, nurse midwife, and nurse anesthetist programs.

I think accreditation is still essential to raise the bar of quality in nursing education, and to set national standards for quality, as opposed to local or regional standards.

What are some common myths about accreditation?

1. It is mandatory
2. It is prescriptive
3. It is “the fox guarding the henhouse”
4. It is either too hard or too easy, depending on who is talking

There are 2364 nursing education programs in the U.S.of these, NLNAC accredits 1500. The remaining are unaccredited, or accredited by CCNE.

How does NLNAC accredit nursing schools?

If you check our manual online, you will see a description of the accreditation process. There are four steps:

1. Self evaluation by the program itself
2. A site visit by trained peer program reviewers
3. Review of the program by a panel of peers
4. Review and decision by the Commissioners

Please tell us about international nursing accreditation.

The process of peer review accreditation is unique to the U.S. and Canada. Other countries typically have governmental agencies, such as a Ministry of Education, that review the quality of education programs, or do not have program review. NLNAC has been in contact with nursing programs from a number of countries around the world that want to learn about accreditation, start their own accrediting organizations, or possibly have NLNAC accredit their programs.

While nursing has some universal characteristics, the education systems and health care systems are very different around the world, as are attitudes about health and illness, so that what is appropriate for nursing education in the U.S. may not necessarily be appropriate in other countries.

How can prospective nursing students use NLNAC with regard to their nursing education and career journey?

We at NLNAC think that nursing students are best served by attending an accredited nursing program. Accreditation is a “stamp of approval” that says two things about a program. First, the program has been reviewed against national standards of excellence and meets those standards. Second, the school is demonstrating its commitment to excellence by going through the voluntary accreditation process. This commitment is not only within the nursing department, but throughout the college. And finally, students who start their careers in an Associate Degree program will find it easier to advance their education to a baccalaureate or Master's degree by graduating from an accredited program, since many higher degree programs require graduation from an accredited program as part of the admissions process.

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NURSING EDUCATION

Big question… Can you tell us in detail about the programs and degrees available in the field of nursing. Please include background and description, degree types, ranges of length of programs, cost ranges, admissions requirements, what careers these programs lead to, etc..

In a nutshell, since this is a big question... Nursing education began in hospital-based programs that combined education and on the job training. Students received a “diploma” following three years of study, but the diploma did not really give the graduate any academic degree. Baccalaureate programs, housed in universities, began in the early part of the 20th century. In the middle of the 20th century the diploma programs began to close. Community colleges began to offer associate degrees in nursing.

Today it is possible to become a registered nurse by graduating from an Associate Degree program, a Baccalaureate program, or a Diploma program. About 60 percent of the newly licensed nurses last year graduated from Associate Degree programs. 25-30 percent of the newly licensed nurses graduated from Baccalaureate programs, and the remaining graduated from diploma programs.

The Associate Degree programs are about 2 ½ years in length. They tend to be the most economical, as most of them are housed in community colleges that have low tuition, and students commute to classes.

Baccalaureate programs are typically 4-4 ½ years in length. Costs vary, depending on whether the college is a public or a private one.

Diploma programs are 2-2 ½ years in length. There are fewer than 100 left in the country. One advantage of these programs is that they are usually housed in a hospital or health care system and there are frequently tuition-forgiveness programs if the graduate works for the hospital.

Nursing is a very flexible career. A student graduating with an associate degree can begin work as a staff nurse and depending on the part of the country, expect to earn a starting salary in the mid-40 to mid-60 thousand dollar range. If a nurse wants to advance in her career, s/he needs a bachelor's degree, and more commonly a master's degree. Graduates of master's degree programs, such as nurse anesthesia or nurse practitioner, can earn salaries that start in the $80,000 range. Nurses work everywhere – in hospitals, clinics, physicians offices, private practice, community settings, industry, insurance companies, government, or teaching. The career is very flexible. Nurses can go on to get MBA or law degrees and move into administration, government, or policy positions.

Can you please provide our readers with a body of important statistics regarding nursing students and nursing education?

Nursing degrees awarded during the 2001-2002 academic year, based on data from the National League for Nursing:
Baccalaureate 30,900 (some of these degrees are for students who are already RNs and going on for advanced degrees
Associate 39,550
Diploma 2291

I do not have information for Masters degrees, but the number is probably around 10,000; doctorates would be fewer than 100.

Very few new nursing schools start up in a given year; based on information we get in the NLNAC office it would be fewer than 10.

The student/teacher ratio in programs varies by course and size of the school. Lecture courses can be as small as 20-25 and as large as 100 or more. Labs are typically one instructor for 10-12 students. Clinical courses (where students are providing care to patients) are typically one instructor for 8 students at the undergraduate level, and one instructor for 1-6 students at the graduate level, depending on the course.

Tuition varies by the school; nursing students are charged the same tuition as other students in the school. Community colleges are the cheapest, private university baccalaureate and Master's degree programs are the most expensive. Most schools charge lab fees that can be pretty high, sometimes $300 per course. The hottest specialties right now are clearly nurse practitioner, which is a master's degree program. Other hot areas are gerontology, informatics, and critical care/emergency room.

Percentage of men and minorities: men are increasing to about 10 percent of enrollment in nursing programs; some schools report male enrollments as high as 15 or 20 percent. Minorities: about 12% Are African-American, 7% are Hispanic, 3% are Asian.

Enrollments vary by type of program, size of the college overall, and program type. A “typical” associate degree program admits 30-60 new students per class. Some admit twice a year, some admit only once a year. Baccalaureate programs are more variable, ranging from 20 or so per year to 100 or more in the large universities. Diploma programs are typically about 50 students per class.

How can high school students best prepare to get into the top 10% of nursing programs in America?

High school students need to prepare for nursing just like they do for any college major. First you get admitted to the college, then you take pre-nursing courses and do well in them before being admitted to the nursing major. Good background in science, math, and English are essential. Computer skills are a must. Foreign language proficiency is a plus in today's multicultural patient care settings.

How can career changers best prepare to get into the top 10% of nursing programs in America?

Career changers can frequently get admitted to nursing programs with advanced standing, since they probably already have at least a bachelor's degree in another field. Many of the liberal arts requirements are waived. Some nursing schools have programs, called Nursing Doctorate programs, designed just for career changers. Or the career changer can go to any nursing program.

Most nursing schools are local or regional – their students are drawn from the region, and their graduates stay in the region. The “top tier” schools are very research-oriented, and do draw students from national and international areas.

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OTHER QUESTIONS

What is right and wrong with Nursing education in America today?

What is right? Nursing is a hot career these days, because there is a tremendous shortage of nurses that is only going to grow. Students can enter the profession after only 2 ½ years of educational preparation. Salaries are getting better. The work environment is very challenging and has lots of opportunities for growth.

What is wrong? The study is very challenging and stressful. Nursing is not for everyone!

What do you consider to be the three greatest challenges facing nursing professionals in the field today?

1. The nursing shortage puts many pressures on the practicing nurse
2. Nursing is a 24/7 profession
3. Patients are sicker in hospitals today, and due to costs there is a lot of pressure to get them in and out as quickly as possible (the “sicker and quicker” phenomenon)

• Do you want an Associate's Degree or Bachelor's Degree to start? Is the program accredited?
• Where do you want to live? You should study in the area where you think you will want to work.
• What is the school's NCLEX (licensing exam) pass rate?
• What is the school's graduation rate? This is important because a school with a high pass rate may flunk everyone out).
• What kind of reputation do graduates of the program have in local hospitals?
• Where do the graduates work?
• How many of them go on to get advanced degrees?
• What do the students think of the program?

What are your opinions and ideas regarding the ranking of nursing schools?

The rankings I have seen are based on a few factors that may or may not be relevant to a student who is just starting her/his education. For example, the U.S. News list of the “best “ nursing schools has large research universities. These schools are wonderful institutions, and their faculty do great research. This may or may not meet the needs of a freshman nursing student.

On the other hand, if the student is looking for a Master's degree or a doctorate, the “best” research schools may be a good place to try to be.

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