Closing the Leadership Gap: Mentoring the RN to BSN Student for Success

Monday, 9 November 2015: 1:45 PM

Jill Borgos, PhD, MS, RN
Deborah Hodge, MS
Anne Sweet, MS
School of Nursing, Empire State College, State University of New York, Saratoga Springs, NY, USA


 Proposal for STTI Biennial Convention 2015

Purpose/Specific Aim: 

The primary purpose of this study was to examine how the “ Campaign for Action” for advancing nursing leadership is unfolding in the labor market for the approximately 60 percent of the Registered Nurses graduating and practicing in the United States who hold 2 year degrees (Benner et al., 2010).  Associate degree nursing graduates often received minimal if any leadership education throughout their curriculum despite the demands of the labor market for increasing nursing leadership (Robert Wood Johnson Foundation (RWJF), 2014, Blais & Hayes, 2010, Yoder-Wise, 2015, Grossman & Valiga, 2009). The specific aim of the study was to identify if and in what ways there is an association between students enrolling in a RN to BSN program and the increasing demand for leadership skills in the labor market. Additionally, the study sought to identify the ways in which college faculty and advisors could provide better educational course content and clinical experiences for RN to BSN students seeking growth in the area of leadership.

            The nursing literature, prominent nursing organizations, and government agencies have acknowledged the critically important need to infuse leadership education and practice into nursing to improve patient outcomes (RWJF, 2014, Blais & Hayes, 2010, Yoder-Wise, 2015, Grossman & Valiga, 2009, Institute of Medicine, 2003).  More specifically, since the release of Keeping Patients Safe: Transforming the Work Environment of Nurses (Institute of Medicine, 2003) and Educating Nurses: A Call for Radical Transformation, (Benner et al., 2010), the discourse on leadership has become increasingly ubiquitous in the nursing literature.  Both of these influential publications suggest a strong association between quality and safety and nursing leadership. The Robert Wood Johnson Foundation (RWJF, 2014) reported that in a systematic review of the nursing literature in 2013 on the association between leadership and quality and safety, transformational leadership in particular is associated with “higher patient satisfaction and lower rates of select adverse events such as patient mortality, medication errors, and hospital acquired infections.”  A number of nursing organizations such as the American Nurses Association, American Association of Nurse Executives, and Sigma Theta Tau International have issued policy briefs about the importance of advancing nursing leadership. Other organizations vested in advancing nursing leadership to improve quality and safety include the Agency for Health Care Improvement, the American Nurse Credentialing Center, and the National Quality Forum (RWJF, 2014).  Recognizing the importance of advancing leadership, Sigma Theta Tau International recently held a national conference in the fall of 2014 titled “Leadership Connection” featuring a plenary session on Models of Leadershipalong with a vast array of other sessions emphasizing the importance of leadership both nationally and globally.  The mounting evidence suggests that there is a leadership gap and that increasing the number of nurses with leadership education and training is a necessary component to improving safety and quality of care.  Given that approximately half of the practicing RNs, those holding associate’s degrees, have had little to no exposure to leadership course content or leadership experience during their 2 year degrees, RN to BSN degree programs can potentially help close the leadership gap by offering both course content and clinical experiences enriched with leadership opportunities.


In this qualitative study, a phenomenological approach using structural coding and analysis techniques in Atlas. Ti., was utilized (Friese, 2012, Marshall & Rossman, 2011, Saldana, 2009).  Approval of the State University of New York, Empire State College Institutional Review Board was obtained to examine n=264 essays written by RN to BSN students describing their rationale for seeking a BSN degree. The study was conducted at a single site large public university in the northeast offering an exclusively online RN to BSN degree. Once admitted, all students in the RN to BSN program, as part of their educational planning process, are required to write an essay explaining their rationale for seeking a bachelor’s degree as well as outlining their future career goals and courses they would like to take in the program outside of the prescribed degree requirements.  De-identifying techniques were used to protect the authors’ of the essays.  The essays were randomly selected from a larger cohort of n= 942 RN to BSN students admitted during the years of 2008-2013. Additional coding and analysis of the data included demographic information and number of years since completion of their associate’s degree.  Structural coding of student rationale essays in Atlas. Ti., enabled the examination of the motivational patterns driving associate degree prepared RNs back to higher education to pursue their bachelor’s degree (Friese, 2012, Marshall & Rossman, 2011, Saldana, 2009).


            Findings suggest that due to a shift in the demand for nurses with leadership skills in the labor market, a number of RN to BSN students are returning to complete their degrees for the sole purpose of obtaining skills and knowledge in the area of leadership to further advance their careers.  Of the n=254 student essays coded in Atlas. ti., n=90 or 35.4% of the student essays revealed that the purpose of returning to complete the RN to BSN degree was to obtain leadership skills. Students frequently stated that they were unable to advance in the areas of clinical ladders, into acute care settings, nurse educator, or administrative type positions since they did not have the requisite BSN degree. In order to gain the qualifications necessary for leadership or promotional opportunities in these areas, students were seeking education and skills in leadership. Interestingly, the BSN degree was referenced repeatedly as the qualification providing the necessary leadership education and training required for advancement.  A general finding among all of the essays is that the nurses did not realize until they were in the job market how limited their opportunity for career grow was having only obtained an associate’s degree.


A significant proportion of RN to BSN students at a public university research site are pursuing a bachelor’s degree in order to gain qualifications necessary to advance in positions requiring education and skills in leadership. Demands in the labor market for nurses with leadership at public and private organizations are increasingly recognizing the value of hiring nurses with leadership skills and in particular those with a bachelor’s degree (RWJF, 2014). Consequently, the demand for leadership skills in the labor market is increasing a demand for additional higher education. Moving forward, these findings are significant for both faculty and academic advisors in terms of program evaluation to ensure that leadership growth and opportunities are meeting the needs of the RN to BSN student population. Education and skills training in leadership should be identified for students through course content, appropriate clinical placements, and connections to professional organizations.  Ongoing assessment and evaluation of the specific leadership opportunities within RN to BSN programs should be highlighted and career advisement tailored to meet the needs of the adult RN to BSN student seeking leadership opportunities ( Sanberg, 2013, Canton & James, 2011, Johnson & Ridley, 2008) .


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Institute of Medicine (2003).  Keeping Patients Safe: Transforming the Work Environment of Nurses.Institute of Medicine of the National Academies.

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Robert Wood Johnson Foundation (RWJF). (March, 2014).  Leaders in Patient Safety and Workplace Improvement. Charting Nursing’s Future:  Reports on Policies that can transform patient care, Issue 2. Washington, DC: The George Washington University.

Robert Wood Johnson Foundation (RWJF). (March, 2014).  Strategies for Future Transformation: Ensure Adequate Nurse Staffing. Charting Nursing’s Future:  Reports on Policies that can transform patient care, Issue 2. Washington, DC: The George Washington University.

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Sanberg, S. (2013). Lean In: Women, Work, And the Will To Lead. New York, NY: Alfred A. Knopf.

Sigma Theta Tau International. (September, 2014).  Models of Leadership. Leadership Connection Conference: Personal, Professional, Global. Indianapolis, IN.

Yoder-Wise, P.S. (2015). Leading and Managing in Nursing (6th Ed.).  St. Louis, MO:  Elsevier Mosby.