Pathways to Registered Nursing: Influences of Health-Related Work Experience and Education Financing

Abstract

A larger and more diverse registered nurse (RN) workforce in the U.S. is needed to meet growing demand and address social determinants of health and improve health equity. To improve understanding of pathways and barriers to becoming an RN, this study examined prior health care employment and financial assistance factors associated with completion of pre-licensure RN education programs, by initial entry degree (associate degree or bachelor of science in nursing) and across racial and ethnic groups, using the 2018 National Sample Survey of Registered Nurses. The study found higher percentages of associate degree-entry RNs held a health-related job prior to completing their initial RN program than did bachelor’s degree entrants. Employer support for education financing as well as reliance on loans and scholarships increased among RNs graduating in 2000 and later, and reliance on self-financing was reported less frequently. Hispanic associate degree-entry RNs reported education financing from only federal loans more frequently compared with White RNs, and higher percentages of Black, multiracial, and “some other race” baccalaureate degree entry RNs accessed federal loans compared with White baccalaureate degree-entry RNs. These findings indicate diversifying the RN workforce should remain a priority to increase representation by underrepresented racial and ethnic groups. Equitable pathways into the RN profession will be facilitated and expedited through policies that overcome financial and social barriers that enable individuals from population groups underrepresented in the nursing workforce to identify with the RN role and route to the profession.

The Workforce Needed to Address Population Health

“…A study also found that Black and Hispanic nurses were more likely than other students to rely solely on student loans for their initial nursing education versus other sources of financing, such as employer tuition support or federal traineeships and scholarships. 50 Clearly, finances present an obstacle that disproportionately affects the kinds of students needed to diversify the workforce and improve population health. Further harming workers from historically marginalized communities is the pay gap that they experience compared with White peers across skill levels, which may also affect a worker's ability to afford future schooling.…”

“…These students were more likely to take on loans, and loans of higher amounts, compared to students from public and not‐for‐profit schools. A study also found that Black and Hispanic nurses were more likely than other students to rely solely on student loans for their initial nursing education versus other sources of financing, such as employer tuition support or federal traineeships and scholarships 50 . Clearly, finances present an obstacle that disproportionately affects the kinds of students needed to diversify the workforce and improve population health.…”