Wednesday, August 07, 2013
The Pros and Cons of Degree Creep
Why are nurses being required to get higher degrees, while teachers are being told not to?
In nursing, there’s a slow but steady move afoot to require nurses to have bachelor’s degrees in nursing, rather than associate’s degrees. This is a major issue for community colleges that, like my own, are barred legislatively from offering bachelor’s degrees. To the extent that hospitals and other desirable clinical sites give preference to students in bachelor’s programs, community college programs have to work harder to provide our students what they need.
Historically, associate’s degrees have been enough (along with the NCLEX exam) to move into practice. Then, those who wanted to could go on to bachelor’s degrees or even higher if they chose. Bachelor’s degree completion programs in nursing -- the courses that nurses who already have associate’s have to take to get the bachelor’s -- are mostly “theory,” as opposed to clinical, so the contribution that they make, while real, doesn’t show up in direct patient care. The piece in Community College Times mentions that there isn’t any actual evidence that nurses with higher degrees give better care. But the move towards the new requirement proceeds anyway.
Meanwhile, North Carolina has passed a law saying that it will stop giving extra pay for teachers who earn Master’s degrees. Many states have awarded salary bumps for graduate degrees for a long time; North Carolina has decided to stop, and, at the same time, to eliminate teacher tenure. The argument being used there is that Master’s degrees don’t necessarily equate to better teaching, so why pay for them?
So in one case, degrees that don’t improve outcomes are becoming more important. In the other case, degrees that don’t improve outcomes are becoming less important.
As someone in the degree-granting sector, I find this curious. Why are we moving in opposite directions on the issue of degree creep?
It could be any number of things. The absence of evidence is not evidence of an absence; just because there’s no actual evidence that degree creep in either profession actually helps patients or students doesn’t mean that it doesn’t help; there may be benefits that the current measures don’t capture. Of course, that isn’t much on which to base a requirement.
I’m inclined to suspect economic motives.
The difference could be a function of who pays. In the case of public school teachers, the government pays. Put differently, in K-12, we have a single-payer system. (Yes, there are private K-12 schools, but they’re unaffected by the North Carolina bill.) In a single-payer system, if the single payer in question decides to get cost-conscious, then that’s what happens. In the case of nurses, by contrast, money comes from a myriad of sources, each with its own agenda.
I assume that both teachers and nurses would like to maximize their pay and social standing, which would suggest that both would be sympathetic to higher degree requirements. (Higher barriers to entry create shortages, which benefit incumbents.) But in the case of teachers, raising the skill level of teachers may or may not directly benefit the school. School funding often has little to do with student performance. I could understand the people who pay for schools deciding that higher salaries for unproven results are not worth it.
The folks who teach graduate programs in education are rightly terrified of this move, but the countermove strikes me as obvious. Find a way to show that the degree is worth it.
In the case of nurses, I suspect there may be another motive afoot. Yes, nurses make decent money, but to the extent that nurses’ skills are upgraded, it’s possible for a practice or hospital to get by with fewer doctors, who are incredibly expensive. In other words, what looks at first blush like an added expense -- higher salaries for nurses -- actually winds up being a long-term savings. I’d expect both health insurers and hospitals to be able to do that math.
The only thing slowing the move to a universal bachelor’s requirement for nursing is the constant need for new nurses. If you took community colleges out of the business of preparing nurses, medical providers would face a supply crash in short order. Even if many of the providers would really prefer to move everyone to a bachelor’s level, right now there just isn’t the labor force to do it. So there’s a sort of gradual ratcheting up, instead of an across the board mandate.
Wise and worldly readers, what do you think? Why are unproven degrees becoming both more and less important?