The Acceptability of Online and For-Profit Nursing Degrees: A Study of Hiring Gatekeeper Perceptions
James W. Kinneer, Ph.D.
Indiana University of Pennsylvania
A national survey of health care recruiters was used to compare their attitudes toward four different RN-to-BSN degree options based on the method of instruction (classroom, online) and the type of college (traditional, for-profit). The analysis was based on the data received from 116 respondents who completed the questionnaire. The study findings revealed significant differences among the four degree options, with respect to the perceived advantages of the hiring process, credibility, concerns about credentials, and likelihood to recommend hiring. More specifically, the study participants favored degrees from traditional colleges and classroom instruction over those earned at for-profit colleges and through online instruction.
The adoption of online learning, which has become a mainstream practice in postsecondary education, has evolved as an integral strategy at even the most prestigious institutions of higher learning (Allen & Seaman, 2013). As for-profit colleges were among the early adopters of online learning technologies on a large scale, this innovation has contributed to their rapid growth (Christensen, Horn, & Caldera, 2011). Traditional colleges have also accelerated their own efforts in the expanding online degree market. Online degrees are now offered by both for-profit and nonprofit public and private colleges (Allen & Seaman, 2013). As a result, adult students seeking to further their education have a diverse range of online degree choices (Levine, 2000). Although popularity and scope of online learning and for-profit colleges continue to grow, it is unclear whether employers' acceptance of credentials earned in these settings is increasing at a similar pace.
Employer Attitudes toward Nontraditional College Degrees
Researchers exploring employer attitudes toward online and for-profit college degrees have reported conflicting findings. Following an early qualitative study, Chaney (2001) noted that employers were suspicious of online degrees. Other authors have also made significant contributions to this line of inquiry (e.g., Adams & Defleur, 2005, 2006; Adams, Defleur, & Heald, 2007). Adams and colleagues conducted a study in which hiring representatives were asked to select the most suitable candidate from a number of hypothetical job applicants holding college degrees earned through either classroom instruction or online instruction. Their findings revealed that those with degrees earned through classroom instruction were overwhelmingly favored. Several other studies have attempted to build on this work and have reported similar results (Danzinger, 2008; Jeancola, 2011; Thompson, 2009). Seibold (2007) and Lamer (2007) found that employers did not regard for-profit colleges to have the same degree of rigor as nonprofit colleges. However, Bailey (2011) concluded that hiring managers did not perceive a significant difference between degrees obtained through classroom and online instruction. Moreover, they did not appear to base their hiring decisions on the for-profit / nonprofit status of the college.
Nursing offers an interesting context for this research topic, as many see online education and for-profit colleges as viable solutions to a critical shortage of baccalaureate degree registered nurses. Although a baccalaureate degree is the minimum entry-level education for most health professions, in 2008, only 50% of registered nurses held this qualification or higher (Health Resources and Services Administration [HRSA], 2010). While the call for nursing to increase its entry-level education requirements has lingered for years, it has gained renewed vigor in light of research that supports the link between the registered nurse educational attainment and patient safety and clinical outcomes (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Estabrooks, Midodzi, Cummings, Ricker, & Giovanetti, 2005; Friese, Lake, Aiken, Silber, & Sochalski, 2008). The Institute of Medicine (IOM, 2010) advocates increasing the percentage of registered nurses with a bachelor degree to 80% by 2020. Several other organizations have added their voices to this appeal, including the American Association of Colleges of Nursing, the American Nurses Association, the American Organization of Nurse Executives, and the National League for Nursing (Tri-Council for Nursing, 2010).
In its report entitled The Future of Nursing: Focus on Education, the IOM (2010) proposed that increasing the number of registered nurses could be accomplished in multiple ways, one of which is education through online courses. Moreover, according to the report, for-profit colleges have an important role as new providers of nursing education. While there is an abundance of literature regarding the nursing shortage and the nursing education imperative, no studies have been conducted on employer perceptions of online nursing degrees and the perceived credibility of nursing degrees earned at for-profit colleges and universities.
Thus, in order to fill this gap in the extant knowledge on this very important issue, the present study aimed to compare the perceptions of health care recruiters serving as hiring gatekeepers, regarding RN to Baccalaureate degrees based on the method of instructional delivery (classroom, online), and the type of college (traditional, for-profit), in order to determine if significant differences exist.
This study used a cross-sectional survey methodology. The study participants were drawn from the population of health care recruiters who were involved in registered nurse recruitment.
The size and complexity of the population presented a logistical barrier to probability sampling. Thus, as central database of all health care recruiters is not available, active members of the National Association for Health Care Recruitment (NAHCR) were defined as a representative subpopulation. NAHCR was founded in 1975 as the National Association for Nurse Recruiters and is currently the leading professional association for health care recruiters. In order to recruit study participants, an invitation email was sent to all active NAHCR members. As the 791 invitations resulted in only 86 responses, a second email request was sent two weeks after the first and resulted in an additional 45 responses. Of these 131 responses, 15 were excluded from all subsequent analyses, as the respondents completed less than 50% of the survey questions. Thus, the findings and conclusions presented are based on the remaining 116 responses.
The researcher developed the survey instrument used in this study after a review of the literature on the topic of employer attitudes toward degrees earned online or from for-profit colleges. The survey instrument consisted of 22 items, including four that addressed the primary research questions for the study. The first research question was:
"If experience and other qualifications were equal, how much of an advantage in the hiring process would a registered nurse job applicant with the following degrees have in comparison to a job applicant with an Associate Degree in Nursing from a community college?"
In order to answer this question, the respondents were given four degree options (TRADITIONAL COLLEGE + CLASSROOM, TRADITIONAL COLLEGE + ONLINE, FOR-PROFIT COLLEGE + CLASSROOM, FOR-PROFIT COLLEGE + ONLINE), which were used as independent variables in the subsequent data analysis. A four-point Likert-type scale was used to rate the degree of advantage (No Advantage, Very Little Advantage, Some Advantage, Significant Advantage).
The second research question was:"How would you rate the credibility of the following nursing degrees?"As above, the respondents were asked to rate each of the four degree options given above, using the four-point Likert-type scale (Very Low, Low, Moderate, High).
To collect data related to the third research question, the next question asked: "How much concern would you have about the credentials of a registered nurse job applicant with each of the following degrees?"
Once again, the four degree options were rated using a four-point Likert-type scale (No Concern, Little Concern, Moderate Concern, Significant Concern).
The last survey question that addressed the fourth research question was: "How likely would you be to recommend hiring a registered nurse job applicant with the following degrees?"
Here, the four degree options were rated using a four-point Likert-type scale (Very Unlikely, Unlikely, Likely, Very Likely).
A space for additional comments was included after each of the preceding questions, allowing the respondents to add comments to clarify their response, if needed.
Limitations to the Study
The primary limitations to this study included the non-probability sampling method and the low response rate, which could affect the generalizability of the findings.
The study participants were 116 health care recruiters involved in the screening and interviewing of registered nurse job applicants. A summary of their responses to demographic questions is given in Table 1.
Gender, Age and Educational Attainment of Survey Sample
31 – 40 years
41 – 50 years
51 – 60 years
Years of Recruitment Experience
The respondents were predominantly female (95%, n = 109), with only 5% male participants (n = 6). However, this gender representation is comparable to the membership demographics of the National Association of Health Care Recruiters. The survey respondents were predominantly older, with 29% (n = 32) selecting 41 - 50 age range, and 40% (n = 45) indicating that they were in 51 - 60 age group. Moreover, 88% of the sample had completed at least a bachelor's degree, including 43% (n = 49) who held a graduate degree. With respect to the recruitment experience, the sample was well-proportioned, as 15% (n = 17) respondents had between 1 and 5 years of experience, 24% (n = 28) had between 6 and 10 years of experience, 27% (n = 31) had between 11 and 15 years of experience, 10% ( n = 12) had 16-20 years, and 23% (n = 27) had more than 20 years of experience. Information regarding the participants' employment setting is given in Table 2.
Employment Setting of Survey Sample Participants
Multiple Hospital/Healthcare System
Long Term Care
Veterans Administration or Military
More than 5,000
The majority of the respondents were recruiters in a hospital setting, including 42% (n = 49) who recruited for an individual hospital, and 45.3% (n = 53) who recruited for multiple hospitals / healthcare systems. Most respondents indicated that they worked for a not-for-profit, non-governmental organization (78%, n = 91). The majority of the sample worked for a larger employer, with 35% (n = 41) indicating that the number of employees was greater than 5,000, and 30% (n = 35) stating that the number of employees was between 2,000 and 5,000.
Research Question 1
RQ#1: Is there a difference in health care recruiters' perceived advantage of an RN-to-BSN degree in the hiring process across the four degree options?
The first research question was addressed by a survey question that asked participants to rate the hiring advantages of a job applicant holding each of the four RN-to-BSN degree options in comparison to a job applicant holding an Associate degree in nursing from a community college. The distribution of ratings is shown in Table 3.
Frequency Distribution for Health Care Recruiter Rating of Perceived Advantage of RN-to BSN Degree in the Hiring Process Across Four Degree Options
Degrees earned from TRADITIONAL+CLASSROOM were rated as providing a significant advantage, as 37.4% respondents indicated this view, compared to 21.7% for TRADITIONAL+ONLINE, 18.5% for FOR-PROFIT+CLASSROOM and 10.5% FOR-PROFIT+ONLINE. A Friedman test was conducted to evaluate differences in the medians among the perceived advantage of TRADITIONAL+CLASSROOM (Mdn = 3.00), for TRADITIONAL+ONLINE (Mdn= 3.00), FOR-PROFIT+CLASSROOM (Mdn = 3.00), and FOR-PROFIT+ONLINE (Mdn = 2.00). The test was significant c2(3, N = 114) = 101.545, p < .01.
For each survey item, an open space was provided for additional comments. Participants that gave comments indicated that a RN-to-BSN degree coming from a school that is accredited was important (noted in 5 of 13 comments, 38%). An equal number of comments indicated that a BSN degree was not necessary for bedside nursing, as other factors (such as experience, skills, and certifications) were important. In contrast, three (23%) respondents commented that the organization currently had, or would be soon implementing a specific hiring preference for BSN degree nurses. Finally, three comments (23%) indicated that the respondents did not assign importance to the source of the BSN degree.
Research Question 2
RQ#2: Is there a difference in health care recruiters' perceived credibility of an RN-to-BSN degree across four degree options?
The second research question was addressed by a survey question, which asked the participants to rate their perception of the credibility of the four RN-to-BSN degree options. The frequency distribution of their ratings is given in Table 4.
Frequency Distribution for Health Care Recruiter Rating of Credibility of RN-to-BSN Degree in the Hiring Process Across Four Degree Options
In response to this question, 86% of the respondents rated the credibility of degrees earned from a TRADITIONAL+CLASSROOM as high, compared to 37.5% for TRADITIONAL+ONLINE, 49.6% FOR-PROFIT+CLASSROOM, and 23.9% FOR-PROFIT+ONLINE. A Friedman test was conducted to evaluate differences in the medians among the perceived advantages of traditional college/classroom instruction (Mdn = 4.00), for traditional college/online instruction (Mdn = 3.00), for-profit college/classroom instruction (Mdn = 3.00), and for-profit college/online instruction (Mdn= 3.00). The test was significant c2(3, N = 111) = 139.079, p < .01.
In the comments the respondents provided in relation to this question, the importance of the accreditation of the school was the dominant theme and was mentioned by 3 of 11 participants that provided comments (27%). This was the only repeated comment in this section. Additional individual comments indicated both support for, and concern regarding, online education.
Research Question 3
RQ#3: Is there a difference in health care recruiters' concerns about credentials of an RN-to-BSN degree across four degree options?
The third research question was addressed in the survey by asking participants to rate the level of their concerns with respect to the credentials of job applicants holding each of the four RN-to-BSN degree options. The frequency distribution of ratings is presented in Table 5.
Frequency Distribution for Health Care Recruiter Rating of Concerns About Credentials Across Four Degree Options
With respect to this question, 14.9% of the participants indicated "Significant Concern" regarding FOR-PROFIT+ONLINE qualifications, 0.9% for FOR-PROFIT+CLASSROOM, 2.7% for TRADITIONAL+ONLINE, and none felt that TRADITIONAL+CLASSROOM was a cause for concern. A Friedman test was conducted to evaluate differences in the medians among the concerns about credentials of registered nurse job applicants from TRADITIONAL+CLASSROOM (Mdn = 1.00), TRADITIONAL+ONLINE (Mdn = 2.00), FOR-PROFIT+CLASSROOM (Mdn = 2.00), and FOR-PROFIT+ONLINE (Mdn = 2.00). The test was significant c2(3, N = 112) = 128.107, p < .01.
In the additional comments provided by the respondents, the dominant theme was related to the practical experience as a component of the BSN degree education, which was mentioned in 4 of 8 comments (50%). These respondents indicated that their concerns were that online programs provide less opportunity for direct patient care experience. One respondent also indicated that, for registered nurses with patient care experience, the source of a BSN was less important. The second most common theme, raised in two comments (25%), was related to accreditation.
Research Question 4
RQ#4: Is there a difference in health care recruiters' likelihood to hire a registered nurse job applicant across four degree options?
The fourth research question was addressed in the survey, whereby the respondents were asked to rate the likelihood of hiring job applicants holding each of the four RN-to-BSN degree options. The distribution of ratings is presented in Table 6.
Frequency Distribution for Health Care Recruiter Rating of Likelihood to Hire Across Four Degree Options
The respondents indicated that it was "Very Likely" that job applicants with TRADITIONAL+CLASSROOM degrees would be hired in 73.9% of the cases, compared to 48.6% for TRADITIONAL+ONLINE, 45% for FOR-PROFIT+CLASSROOM, and 30.9% FOR-PROFIT+ONLINE. A Friedman test was conducted to evaluate differences in the medians among the likelihood to hire between TRADITIONAL+CLASSROOM (Mdn = 4.00), for TRADITIONAL+ONLINE (Mdn = 3.00), FOR-PROFIT+CLASSROOM (Mdn = 3.00), and FOR-PROFIT+ONLINE (Mdn = 3.00). The test was significant c2(3, N = 108) = 104.506, p < .01.
The comments pertaining to this survey question revealed that factors other than the source of the RN-to-BSN degree weighed heavily in determining the likelihood to hire. Of the 15 comments given, 9 comments (60%) in some way mentioned the importance of experience, clinical skills, customer service, teamwork, performance in the interview, and overall organizational fit in making a hiring decision.
The findings of this study revealed significant differences in the perceptions of health care recruiters across the four RN-to-BSN degree options. In particular, RN-to-BSN degrees from traditional colleges and classroom instruction were viewed more favorably than the remaining three alternatives. The credibility of RN-to-BSN degrees from a combination of traditional college and classroom instruction was rated much higher and was related to a greater likelihood to hire such applicants, while RN-to-BSN degrees earned from for-profit colleges and online instruction were viewed least favorably. Subsequent analysis of the comments pertaining to each research question revealed that the accreditation of a RN-to-BSN program is a common theme in evaluating a degree, and additional factors—such as experience and organizational fit—are often considered in the hiring process.
This study was significant because of the rapid growth of online and for-profit college education and the proposed role for these options in increasing the educational attainment of registered nurses. While this study cannot conclusively clarify the contradictions in the current literature, it does suggest that employer attitudes toward non-traditional college degrees have not significantly changed, despite the continued increase in enrollment in these alternatives to traditional, residential higher education programs. If online education and for-profit colleges are to fulfill their role in addressing the shortage of baccalaureate degree registered nurses, as proposed by IOM, it is critical to consider the perceptions of employers revealed by this study. Another major conclusion of this study is that job seekers need to carefully evaluate the reputation and perceived quality of a college degree prior to making an enrollment decision. This study has shown that the convenience and flexibility of online and for-profit college degrees may be offset by an unfavorable employer's perception of the quality and rigor of the academic experience. Further research aiming to understand the perceptions of hiring gatekeepers is thus warranted.
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Online Journal of Distance Learning Administration, Volume XVII, Number II, Summer 2014
University of West Georgia, Distance Education Center
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