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?

Comments:
In my region of Pennsylvania, we actually have an overabundance of RNs according to employers--One large hospital told me that they have a stack of RN resumes that just continues to grow and collect dust. Incumbent RNs are being asked to take on more supervisory and leadership roles in some of our acute care settings though, so the BSN, while rightly observed may not be as directly associated with direct patient care, seems like a logical solution for us. Whether or not BSN programs are going to be able to accommodate that need? To be seen...

Looking at LMI, I have a feeling my region is not alone when we look at RN degree output vs. demand as in this recent EMSI report: http://www.economicmodeling.com/2013/07/31/in-the-spotlight-higher-ed-degree-output-by-field-and-metro/

We were fortunate in my state a few years ago to have training funds for RNs when the shortage seemed critical, but perhaps we went overboard and enticed many into this career pathway who didn't 100% understand what that job entailed. Turnover among new RNs can be a struggle for employers from what I hear, so the BSN might be better suited to existing employees who are ready to take more leadership roles in their current settings.

With demographics though, it does make sense that those resumes may be dusted off after a few years as the aging incumbent RN workforce retires and becomes a part of the ever increasing population who will need RN services. From how I see it in my small corner of the world, we're in a cycle and out of touch with employer/service need pumping out those degrees. If community colleges can help their unemployed and underemployed RNs climb a career ladder and please employers and patients, ready for when that next generation of RNs hit the floor, I'm all for it.

I also live in a health professional shortage area where we are questioning legislatively in many healthcare settings the roles and services that RNs can provide (for less cost as you noted than an MD)...My inclination is to believe that healthcare occupation definitions are going to continue to be in flux as we evolve with the implementation of PPACA, state choices with Medicare expansion, e-med records, etc. As community colleges, our role is to be flexible and responsive to help ensure that the employers, customers, students, and workforce are able to adjust.

As to teachers, we're also undergoing some reforms like many other states across the country. A MA does not produce a good or great teacher, in my opinion. We're looking at performance in new ways every day, and I agree that graduate studies professors in education should be concerned. Perhaps a study has been conducted (where? must be?) variances in student outcomes in K-12 based on teacher qualifications/degrees...Would like to see that before I form an opinion on that one...
 
There have been many valid studies which find that better educated nurses (BSN) as well as other variables contribute to lower mortality rates in hospitals. I easily found such a study:


I think there is proof that the more BSN nurses a hospital has are positively correlated to better patient outcomes. Why? I haven't read enough studies to know.

As to teachers: I don't know of any studies which show students benefit from teachers having higher degrees. Having been a teacher with a Masters degree, I can say from experience that the graduate courses which I took helped me be a better teacher. I gained more in depth knowledge in methods of teaching and subject matter. I also gained more understanding of psychology and learning theory. I felt this higher education helped me in working with my students to help them achieve success in class subjects.

I think teacher salaries are too easy for state legislatures to keep low since teachers' salaries come from a single pay. In some states, legislatures may use the "show us that we are getting more value from teachers for the money we are paying" argument as a display of fiscal responsibility and not "wasting" taxpayers' money.

Personally, I think teachers are underpaid and providing suitable teaching salaries contributes to excellence in education of students.
 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586978/
is the nursing study mentioned in Anonymous 9:48.

I enclosed the url in brackets and I think the brackets kept the url from being displayed.
 
You do realize what else the NC legislature has been up to recently? This is not a group of people who show any inclination to take matters like "evidence" into account in shaping their policies. These changes (and especially the end of tenure) are part of an ideological battle plan against public education itself.
 
As to Anon @9:58's comment about studies showing what characteristics of teachers usually lead to better student outcomes...

Wilson, Floden & Ferrini-Mundi prepared a major report in 2001 (I don't know of any newer work, but I'm willing to be there is) available from the Center for the Study of Teaching and Policy from the University of Washington... They basically found that the only fields that even had studies directly looking at effects of content classes were reading, science and math. Thus, they can only talk about them.

A couple findings:

1) A math major vs. a math ed major doesn't show any benefit. In particular, both have rule-dominated knowledge of the school curriculum and little ability to do anything but present algorithms. A masters degree in mathematics had no value in terms of student achievement or the teacher's ability to present material.

2) In the two correlational studies, researchers contend that education coursework was a better predictor of teaching success than subject matter major or GPA prior to entering the teacher education program.

3) Science courses, past the BS, were positively correlated with increased student scores.

4) A subject-matter or STEM-ed degree was beneficial in comparison to an out-of-field degree in terms of student achievement.


**Also, the IHE piece has no actual research in it and the comments seem to have even less interest. How hard would it be to find just a bit?


Here are a couple of newer studies, but they're not much newer (2003-5):
http://ipp.missouri.edu/files/ipp/attachments/teacher_preparation_and_student_achievement_-_reviewing_the_evidence.pdf

http://www.epi.org/publication/books_teacher_quality_execsum_intro/

http://cmse.tamu.edu/pdf/FinalInitialreport-TexasScienceInitiative.pdf

One from 2010:
http://www.nap.edu/catalog.php?record_id=12882
 
My first finding is poorly stated...

It should have said, "no effect in terms of their useful knowledge of the subject for school teaching."
 
Having run the non-teaching side of an RN to BS program at a private SLAC for 4 years, I can state that there is a drastic difference from the AA/diploma nurse that starts the program and the BSN nurse that leaves it. And yes, studies have shown that mortality rates are lower with an increase in BSN nurses.

My sister is a BSN nurse who is almost finished with her MSN. She wants to move off the floor and into teaching and having seen her fair share of doctors from intern to resident learning the ropes is...you'd really rather have a nurse work on you. So, I can understand those hospitals that are hiring more nurses and less docs.

If I'm coherent enough when in the hospital, I always ask my nurse if they have a BSN and if not, I talk about their plans for more education. Mostly to promote the great RN to BSN options my state has.

Do RN to BSN programs teach nurses how to find veins better or listen to heart beats better? No. They do teach communication skills and a larger understanding of policy and community health. All of those things do lead to improved patient care.
 
Keep in mind that the quality of MEd programs varies drastically, and it's my impression that the weak ones far outnumber the strong ones, at least in my large metro area. Legislators in NC and decision-makers elsewhere are probably responding to the fact that only some MEd programs add value.

Nursing programs must adhere to far more demanding guidelines and oversight. And also keep in mind that the roles in nursing (as you noted) are diverse; roles in K-12 teaching vary by age level and by content, but not by the basic approach that is taken. It totally makes sense that some of those nursing roles require more education, especially roles that involve supervision and/or independent practice.

And, as noted above, there is research to support added value for patients if nurses have a BSN.
 
The difference between a BS RN and an AS RN would also depend on the college program. I'll take an RN from a selective AS program with 100% pass on the licensing exam over a BS program where the pass rate is poor. Our local hospitals used to have a preference for BS for internal promotion, but no longer. I trust they based that decision on evidence.

I'll second DD's comment about the differences being mostly theoretical, since we could convert our AS program to a BS program without having to add any non-nursing classes to our curriculum. We would just have to require higher-level STEM classes that are already in our science curriculum. My conclusion is that selectivity is an important factor in the quality of nursing outcomes.

That mix of results in those ed studies (some of which seem contradictory) probably result from mixing K-8 and secondary ed in the same list. Math Ed (secondary) is pretty solid on the content side. Ed Ed is not and IMO the failure to teach fractions (one prime example) is due to teachers who don't know them very well themselves and who might actually hate math. An Ed masters will not help this problem.
 
I know teachers whose skills were improved through their advanced degrees. I also know teachers who obtained additional graduate degrees in unrelated fields for the sole purpose of increasing their pay and, more importantly, their pensions. In my state, one need not get administrative approval before undertaking graduate work, it's the one sure way to get a raise. Once you have the degree, any degree, under the contract your pay goes up.

NC might want some administrative input in that process, but failing that, eliminating the extra pay for graduate degrees is a ham-handed way to regain control.
 
I think you hit the mark with the long-term goal part and missed it with the private vs. public payer. In Western Province (to borrow DD's phrase of Northern Town), health care is single-payer much like education, and we are also experiencing degree creep in nursing. The community college in Prairie Town no longer offers the ability to sit down for your RN licensing exam after 2 years, but is now in a 2+2 deal with universities.

What I strongly suspect is happening in the nursing programs is that the Province would like to be much more reliant on nurses and less on doctors; nurse practitioners are becoming much more popular to "lighten" the workload for doctors. Personally, I think the Province is just kicking the can down the road since labour is being replaced with a cheaper labour, and public sector labour costs seem to invariably increase over time. Be that as it may, there are short and medium-term cost savings to be had by replacing some doctors with nurse practitioners, and that requires more education (or so I'm told).

In my area, degree creep is being helped by lacklustre hiring in the economy. As opposed to a few years ago, there are now numerous applicants for every position, making it easier for employers to not only demand extra education, but experience to boot. That scrutiny places a premium on extra education, so degree creep is boosted.
 
CCP, you and I can agree about this:

Ed Ed is not and IMO the failure to teach fractions (one prime example) is due to teachers who don't know them very well themselves and who might actually hate math. An Ed masters will not help this problem.
>>>>

But, neither will a math major!

I'd suggest that if you were interview a bunch of math majors they'd all have problematic understandings of fractions, maybe the top 10% could talk to you in terms of the language of groups, rings and fields, but I'd rather have elem ed folks take a crap-ton of classes about elementary grades mathematics (just what it is), and how to teach it. But, a math department would (probably) not want to call this a math degree (because we are math snobs), so you're stuck with some sort of Ed degree.



Also:
Math Ed (secondary) is pretty solid on the content side.
<<<
I agree that they typically take a decent amount of content, but much of it appears to have little value. I would much rather have them take 2 classes where they really explore school mathematics than a semester of abstract algebra. They don't get anything out of algebra... (They assign it to "it doesn't relate to my future work," and treat it as, "pass and forget." Moreover, really, the content is questionably related to the way that 9-12 math treats numbers, polynomials and the like).

I would rather have them spend a lot of time getting smart about functions, quantitative reasoning, and how kids think about those idea than what they do now, many of them don't see logs from the end of the calc sequence til they return to the classroom (except maybe as an isomorphism) and, as a result, have no additional knowledge about them than when they were high school students.



 
There are a number of problems with proving that a masters matters in teaching is worthwhile. There isn't a straight line from masters to student learning -- there are a variety of variables that have to be accounted for. And, there isn't a single flavor of masters degree. In our professional licensure program, for example, our students' time is split between general ed courses that should be helping them learn how to do data-driven decision making, develop strong units, and serve the needs of diverse learners and content courses that are uniquely designed for teachers. Our professional program in math, for example, has courses on algebra, geometry, statistics, and calculus that are designed to tackle the issues and content related to teaching high school students -- we take the K-12 math and really dig into it. (In the fall, I will be teaching a course for middle school teachers on proportional reasoning - content that is directly relevant to what they teach). We teach this way because it's what the research shows makes a difference -- teachers need opportunities to develop content knowledge for teaching which means being able to really understand the content they teach, have ways of supporting students in making sense of it, and know something about the kinds of problems students are likely to have with that content. But, that isn't what all masters programs are like. So, even if our graduates were successful in becoming better teachers, they are part of a larger pool. That pool could have come from a variety of other models for masters-level education. Many masters-level programs, for example, engage teachers in college-level mathematics courses designed for math majors. While this undoubtedly raises their understanding of mathematics as a discipline and their own self-efficacy with regards to mathematics, it seems less likely to have an immediate impact on their students' learning. I am a HUGE fan of masters degrees for teachers, but I think we need to either agree on what that means or quit treating them all the same, because they simply are not.
 
Good question. Many strands here.

1. The questioning of the masters degree in teaching is not just a USA phenomenon.

Example here, NY Times story from India:

http://www.nytimes.com/2013/07/29/world/asia/delivering-a-jolt-to-indias-teacher-training.html?pagewanted=all&_r=0

2. Measuring teacher performance based, in part, on test growth in scores (controlled for student demographics) is a fairly new one.

Just a few years old in some districts; still in planning phases in most. Hotly contested, of course. "Stickiness" of this effort remains up for grabs.

The idea of measuring teacher prep programs based, in part, on outcomes (how their alumni fare with real kids) closely follows.

As a result, we may see a shift:

a) less gov't investment for "any credential" per your North Carolina story, but

b) greater willingness to pay for degrees which do seem to correlate with measurably better teachers...

I'll say this: when I started a small grad school of ed here in Massachusetts, even some very liberal elected officials were very interested in the notion that we wanted to be held accountable entirely based on outcomes (how our teacher alumni fared), and needed some freedom on inputs...
 
timfc makes an outstanding point about teaching functions and quantitative reasoning, both weak points for HS graduates who have an otherwise strong background coming into a college STEM program. There are plenty who still don't understand functions after passing calculus.

But that last detail is my main point, reinforced by what museyme says about the importance of teachers actually knowing the content. The problem isn't whether someone has a "problematic understanding" of fractions, the problem is that someone cannot tell if an answer is correct without a calculator, a test bank, or an "instructor edition" and teacher's guide. [This is exacerbated by algorithm-free curricula akin to "look say" reading instruction, which depends even more on having a teacher who has a deep understanding and can also make up examples on the fly and know the right answer.] I've met someone who is the math expert at a K-6 school solely on the basis of being the only teacher in the school who is not afraid of math.

Finally, remember that some of them are teaching an AP class based on only a few upper division undergrad math classes, nowhere near the qualifications required to teach the calculus course that a test will say their students have passed.
 
The degree creep affects other areas as well.
While in nursing one could argue that medical advances require nurses to handle more complex procedures, I find it astonishing that human resource professional need to be "recertified".
In the institution where I teach, folks are given no credit for out-of-field master's degrees, but the decision is made by whomever is in power at the time and favoritism or nepotism is known to occur.
We are now in a rather odd situation where the present Kahuna believes that one who does not possess an Ed degree is not worth its salt, and exerts undue--and illegal-- pressure for folks to obtain an Ed degree.
At the center of this storm is this differentiation and data-driven instruction, which to us are unproven theories and therefore we do not want to implement them or even train teachers to implement them.
We want to present these as theories among theories and to discuss pros and cons, while the present administration believes it's gospel and we are stupid not to accept it because we dod not have Ed degrees.
Sorry to say, but in my many years of teaching I have met very few people who make good use of Ed degrees.
 
One confounding factor for advanced education in teachers is the school environment. Where I work we are ignoring 20 years of research in physics education because our admin values consistency among teachers, and all but two of my colleagues just want to do it the old way so refuse to change.

Very frustrating being forced to avoid using better methods because a hot-shot with a non-subject degree is playing politics.
 
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