Utilizing the community capitals framework, this paper analyzed political, human, and financial capitals to understand the role of community colleges in conferring BSN degrees. Through case studies of two states, Colorado and Arizona, this paper examined how community colleges successfully transform political, human, and financial capitals into additional community assets aligned with addressing nursing shortages.
One in five U.S. residents live in rural communities, but according to the Health Resources and Services Administration (HRSA), more than half (61%) of Health Professional Shortage Areas (HPSAs) are rural. The lack of health professionals in rural areas hinders essential access to preventative chronic condition care for rural residents. Rural postsecondary institutions are well positioned to train the local health workforce with individuals who are more likely to practice in rural regions. Some rural community colleges have met this need through Registered Nurse to Bachelor of Science in Nursing (RN to BSN) programs, which provide a pathway from the Associate’s in Nursing (ADN) to the Bachelor’s of Science in Nursing (BSN) degree.
This paper analyzes the role of community college RN to BSN programs in rural health workforce shortages to answer two questions: 1) How do community college RN to BSN programs address nursing shortages? and 2) How does the political context affect the passage of legislation in support of these programs? To answer these questions, this paper examines how RN to BSN programs impact health in the regions they serve by analyzing the effects on political, human, and financial community capitals, or assets in which communities can invest to generate new resources that further strengthen social, economic, and health security (Flora et al., 2016). As regional public institutions, community colleges often operate in locations where residents may lack access to four-year institutions. Community colleges enroll 46% of the nation’s postsecondary population and the largest share of adult learners. For every 10 additional miles required to travel to the nearest four-year institution, individuals are 3.6% more likely to attend a community college. As such, some community colleges serving rural regions without access to four-year BSN programs are seeking approval for RN to BSN programs to create accessible opportunities and respond to local workforce demands.
Colorado was the tenth state to allow community colleges to confer four-year degrees in 2010, and Colorado Mountain College (CMC) became the first Colorado community college to do so. CMC offers five baccalaureate degrees, including a BSN program. The district’s BSN degree is offered at four campuses—Breckenridge, Salida, Glenwood Springs, and Steamboat Springs—each of which is located in a county that is designated as an HPSA. The only college or university operating in the communities its 11 campuses serve, CMC provides affordable access to rural students that otherwise are underserved by higher education in their local community.
Colorado allowed CMC to offer up to five baccalaureate programs in 2010 through Senate Bill 10-101. Once approved, CMC’s five baccalaureate programs effectively addressed local workforce needs. In response, Colorado passed additional legislation, House Bill 18-1086: Community College Bachelor Science Degree Nursing, in 2018 with bipartisan support. As a result, more than 300 community college students are enrolled in RN to BSN programs at six additional community colleges. Colorado’s experience with both laws demonstrates the political capital that communities were able to garner to transform its norms and values into rules that built other capitals within rural communities.
Community colleges provide technical training and serve as an important stakeholder in the human capital of a region. CMC developed performance objectives to address disparities between Latino and non-Latino enrollment, retention, and completion in 2013. By 2020, Latino students had the highest completion performance among all groups and had grown to nearly 28% of enrolled students. The college was designated a Hispanic Service Institution in 2021 asa result of their continuing efforts to provide historically underserved students with the opportunity to build human capital—and thus financial capital—that will strengthen their local communities. CMC’s RN to BSN program boasts a high success rate with every student employed after graduation in 2021. Each CMC campus serves a county designated as an HPSA. CMC’s RN to BSN programs strengthen the local health workforce, increase access to health services, and build financial capital within CMC’s service area.
As a local district, CMC collects local taxes and lowers the tuition for students living within the tax district. This allows the college to operate multiple campuses and uniquely serve smaller, rural markets. Students who live within CMC’s tax district pay $130 per credit hour for tuition, which is $100 less than Colorado residents outside the CMC district pay at the in-state tuition rate. CMC also offers a $1,000 scholarship to all graduating in-district high school seniors. Among the eight postsecondary institutions offering RN to BSN programs in Colorado,CMC was the most affordable by between $100 and $450 compared to other institutions in Colorado for its baccalaureate degree by per-credit tuition and among the most affordable in the country according to the Colorado Department of Higher Education and the U.S. Department of Education. As an institution established to serve its immediate community, CMC provides a cost-effective alternative within the communities that CMC serves for local nurses to pursue their BSN degree.
Arizona became the twenty-fourth state to allow CCB degrees in 2021. Historically, Arizona has not allowed community colleges to confer RN and BSN degrees. Therefore, Eastern Arizona College, located in Thatcher, Arizona, established transfer agreements with state universities to serve students who could not leave the region to pursue a BSN degree. New legislation in 2021 allows community colleges to confer CCB degrees—including RN to BSN degrees—but sets varying rules for rural- and urban-serving institutions.
Arizona’s first attempt to allow CCB degrees came in 1997 as Rio Salado College, a community college located in the urban community of Tempe, sought approval to confer baccalaureate degrees. Previous attempts in Arizona had emerged from urban community colleges, but Eastern Arizona College gradually built political capital within its community during the 2020and 2021 session as a rural institution seeking approval to confer baccalaureate degrees. Opponents of CCB degrees, including the Board of Regents (the state’s governing body for higher education) and four-year institutions lobbied against the 2020 legislation, which passed through the House but failed to get the necessary votes in the Senate Education Committee. In May 2021, however, Arizona passed legislation that built on previous attempts to allow all community colleges within the state to confer baccalaureate degrees but set separate requirements across rural and urban institutions.
EAC and Arizona State University’s concurrent enrollment RN to BSN program has a lower tuition rate than similar programs across the state. Students pay a tuition rate slightly over half of what full-time Arizona State University students pay for their traditional program. The lower tuition, along with the potential increased earnings and wealth of RN to BSN graduates, helps build financial capital for individuals, and thus the larger community. While the concurrent enrollment program allows students to pursue a BSN degree within their local community, it does not simultaneously build human and financial capital in the way that a CCB program does.The lower tuition rate is an important step to making the program accessible to students in the Gila Valley, but it is still more than three times higher than EAC’s ADN degree at approximately $84 per credit hour. If EAC begins offering an RN to BSN program under the new law, there is a greater potential for minimizing debt among students by offering a lower tuition rate.
The case studies of CMC in Colorado and EAC in Arizona suggest two criteria that both states used to determine where CCB degrees, including RN to BSN degrees, should be allowed: