Just two weeks into college, class of 2021 nursing-hopefuls slumped in chairs sank even lower when they were told by a nursing administrator to consider changing their majors because of the limited number of positions open for the school's clinical program.
Freshmen nursing students’ dreams were disrupted in August 2017, after attending a Chill ‘N Chat, a periodic dormitory educational meeting that takes place at Taylor Place residential hall.
ASU nursing hopefuls, called competitive-entry applicants or just "competitives," apply after their first two years of college to enter a clinical program to learn hands-on skills.
Direct entry nurses, on the other hand, are accepted on the basis of high school accomplishments and college admissions tests. Based on the last five years' trajectory, there may soon be no room for competitive students in the program, as direct-entry students continue to take more and more seats.
This was the harsh reality most competitive nursing students at the 2017 Chill 'N Chat meeting were forced to confront.
Withdrawing to her dorm room, now-sophomore nursing student Ashley Moe called her parents crying, wondering if she and they had made the wrong choice.
“I remember, vividly, calling my mom, crying,” Moe said. “They literally said, ‘if you are a competitive, you need to start thinking of other majors. And they were like, ‘we just don’t have enough room. Nursing shouldn’t be your only option.’”
Data provided by the Edson College of Nursing and Health Innovation show a sharp decline in the number of competitive nursing students who were accepted into the school since the summer and fall semesters of 2014. This upcoming semester, just 29 competitive nursing students will continue their careers at ASU, a 77% decline from 2014, the earliest year for which the Edson College provided data.
That's a 16% acceptance rate for competitive nursing applicants. Meanwhile, the share of seats occupied by direct-entry nursing students has steadily risen since 2014.
The rest of the cohort of nurses fight for the few positions left to continue in the nursing program, inflating competitive nursing GPAs to near-perfect.
Nursing students who were not accepted in the summer or fall semesters have the option to apply for the spring. However, recent trends suggest that option is also becoming dominated by direct-entry applicants.
Administrators at the Edson College, like other leaders at nursing schools across the country, are working to open up more clinical positions through partnerships with local hospitals to provide flexible opportunities and investment in technology for the high volume of nursing students entering the University.
On the other hand, there are a limited number of clinical positions at local hospitals partnered with its nursing program.
“Another avenue that we’ve done to increase capacity is to go Saturdays and Sundays and evening rotations, and we’re exploring night rotations because some of the hospitals are saying to us, ‘if you want to do clinicals on nights, we would be happy to have you here,” said Kathleen Fries, program director and clinical professor at the Edson College.
Clinical hours are a vital part in the education of those in the medical field, providing hands-on learning and preparing nurses and doctors for what they will face in their careers.
The Edson College's efforts to maximize its training of nurses include investing in new technology. Before facing real-life scenarios in hospitals, nurses and doctors use simulated sites — a fake lab with an automated patient controlled by an instructor – to earn clinical hours outside the hospital. They use mannequins that can be inserted with IVs, display “breathing” and show heartbeats on scanners.
But many nursing students, especially those competitively admitted in the class of 2021, will not experience those facilities at ASU.
Dreams On the Mend
Moe said she set her sights on being a nurse in pediatric oncology in sixth grade after her best friend passed away from leukemia at 12 years old. Her friend's nurses were “a big part of her journey” through treatment and chemotherapy, becoming her makeshift family as her parents worked to pay medical bills.
Moe started looking at nursing schools her senior year of high school, mainly applying to out-of-state colleges due to the low acceptance rates of California programs. She applied and went to orientations at Boise State, Montana State University, University of Nevada Reno, NAU and ASU.
After attending all those orientations, Moe chose ASU.
“Clearly (ASU) put on the best show,” Moe said. “I went to all of the orientations and all of the 'More To Explore' types of things. I went with my mom, and we met with the counselors from each school."
At the University of Nevada Reno, Moe said advisers told her “our program is very competitive,” but “keep your grades up, mostly A's, and you could get in.”
Therese Speer, the senior program director and clinical associate professor of the clinical nursing program, said there is a delicate balance between direct-entry and competitive nursing students.
“We’re watching it really carefully," Speer said. "Student services watches every single semester, and they keep an eye on the trend of what students are doing."
The nursing adviser at the Chill ‘N Chat outlined the improbability of getting into the nursing program given the total number of students and the number of reserved spots for direct entries, said four nursing students present at the meeting.
"This is one of the most difficult programs for a student to go into," Speer said. "But you have that collaboration with the faculty and the students that’s going to dedicate them to success."
Brittany Ardave, a sophomore majoring in community health, was present at the 2017 Chill N' Chat. She said the adviser told them that direct entries controlled so many spots that competitive nursing students should consider changing their major or face the steep challenge of being one of the handful of competitive students out of hundreds to be accepted to the nursing school.
“I didn’t come to ASU to be a community health major," Ardave said. "That’s not what I want. I’m not going to continue to be a community health major if I can’t get into their program."
Keri Ohlinger was a direct-entry nursing student but lost her spot last year because her GPA fell below 3.5 because she was too busy with work, she said. She met with her counselor after she was notified to see what she would have to do to continue her nursing track.
“After that meeting, I think I maybe felt a little bit more hopeful because she was really positive about it,” Ohlinger said. “By the end of this semester, I think I realized it maybe doesn’t look so good.”
The hurdles the students must overcome to get into the program are taller than ever and are growing with each new class. Fries said the “new number” GPA — a compilation of the pre-required classes for nursing excluding unrelated field of study and extracurriculars — for entering the clinical program as a competitive nursing student is 3.9. The new GPA hurdle was discussed in the week leading up to Moe's statements to State Press Magazine.
For a cross-program perspective, the median GPA for ASU's Sandra Day O'Conner law school is 3.76, the median GPA for the graduate program in psychology is a 3.5 and the median GPA for graduates entering the sustainability school is a 3.25.
Fries said that this focus on high school GPA and ACT scores, which largely based on math and science, has directly resulted in higher scores by ASU nursing students on the state nursing board exam. ASU's nursing program posts a 95.5% passing rate for first-time test-takers.
“We want people to come in with a strong core ethical belief system, patient safety, patient safe care, being an advocate," Fries said. "At the same time, we need nurses who are competent and confident in math and science skills because those relate directly to which type of student is successful in our nursing program.”
New path
Nurses are in high demand, and the career pays well. In the U.S., nurses earn $33.65 per hour wage on average, according to the Bureau of Labor Statistics.
“That is expected to intensify as Baby Boomers age and the need for health care grows,” according to the American Association of Colleges of Nursing’s website.
By 2025, Arizona will face a nursing shortage of greater than 28,000 nurses, the most extreme shortage in the country, according to a December 2014 analysis by the U.S. Department of Health and Human Services.
In order to work against this labor shortage, the Edson College of Nursing and Health Innovation and ASU partner with Maricopa Community Colleges nursing programs.
“That is a wonderful partnership that we have with our community colleges,” Speer said. “Arizona started that, and we thank God for (the community colleges) because they have been a big help with helping to identify other avenues to address the nursing shortage in the nation and in the state.”
Months after the Chill ‘N Chat, knowing that over 100 students would not be selected for its program, the Edson College provided students with information about community college partnership programs for nursing, Moe and other competitive hopefuls said.
However, the information provided was lean, students said, and advisers were not knowledgeable about the needed paperwork for the community college programs.
Several students said they were left to find out the necessary requirements to transfer to clinical programs at community or private colleges on their own with the cost coming close to $1,000.
Maricopa Community Colleges require two english credits to transfer to their program. Because Moe had taken advanced first-year composition, she was forced to take a 6-week online winter course at MCC.
These prerequisites were required before Moe could even apply to MCC. Students have classes at ASU and nursing school at the community college they choose to attend through the concurrent enrollment program, or CEP. Therefore, students pay for credit hours at ASU and the community college they choose to attend. Students in the CEP program would pay for bills at both colleges, costing approximately $23,000 for in-state residents. Nursing students at the Edson CONHI program pay between $28,644-$30,592 for in-state costs. Students in the CEP will receive a degree from both colleges upon graduation.
Moe’s knowledge of these processes came from word-of-mouth and first-hand experience. When one of Moe’s friends asked for a list of what to do before applying to MCC, Moe said she wrote a full-page document of the intricacies and contacts needed to be prepared to apply.
“I asked (my counselor) abut the CEP program, she didn’t really tell me,” Ohlinger said. “I just kind of heard it from other students, so I think that’s another option I could do. She also recommended I should try seeing if there are any other majors I’m interested in if this doesn’t work out.”
Ohlinger is attempting to rehabilitate her GPA after falling below the 3.5 GPA threshold. She now faces the up-hill battle of competing with nursing students who will likely post an average GPA at or near 3.9.
Ardave chose to leave ASU and transfer to Chamberlin University next semester, a for-profit nursing school in Phoenix.
When she was first interviewed, Moe applied to ASU’s nursing program with a 3.79 GPA and was not as hopeful about getting in as she once was. She said she is proud of what she has accomplished so far but realizes it may not be enough for the ASU nursing program.
State Press Magazine followed up with Moe after the Edson College notified competitive applicants of their admission status for the coming fall semester and Moe was not admitted to the nursing program.
Still, Moe is determined to be a nurse no matter how arduous the path.
“I think that if I change my major, I just feel like I’ll regret that for the rest of my life," she said. "This might be the most stupid thing I’ve ever done and it might take me six years to get through college just to get a BSN … but I just want to work with kids. I want to work with sick kids.”
Corrections: A previous version of this article referred to the nursing school as the College of Nursing and Health Innovation, or CONHI. The Edson college changed its name from the College of Nursing and Health Innovation on March 25 to the Edson College of Nursing and Health Innovation after a donation from the Edson family.
A previous version of this article incorrectly stated, "Maricopa Community Colleges do not transfer the English credits from ASU, so Moe was forced to take a 6-week online winter course at MCC." Students are required by Maricopa Community Colleges two first-year composition courses such as English 101 and 102. Completion of advanced composition at ASU does not alone fulfill the requirement for transfer, although the credit is accepted for the first semester of English at Maricopa Community College.
Clarification: A previous version of this article did not state the difference in cost between the CEP and the Edson College of Nursing and Health Innovation. The total cost for the Concurrent Enrollment Program is approximately $23,000 for in-state students. By comparison, the nursing program at ASU ranges from $28,644-$30,592 for in-state residents.
Reach the reporter at cbudnies@asu.edu and follow @ChaseHBudnies on Twitter.
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