For college grads

For college grads

April 22, 2007 - The April 15 issue of PARADE magazine included a careers feature that listed "registered nurses" as one of "The Hottest Jobs (No College Degree Required)," rather than in the category of hot jobs "For College Grads." PARADE is included in many U.S. Sunday newspapers, and it has a readership of some 80 million people. The magazine's description of nurse training was very misleading. The great majority of nurses have at least an associate's degree from a college (which typically takes three full years to earn). About half of nurses now have at least a bachelor's degree. And the few hospital-based diploma programs that remain require three years of college-level training. The PARADE item brought a swift response from nurses on the magazine's web site, and from nursing leaders including Linda Burnes Bolton, DrPH, RN, FAAN, president of the American Academy of Nursing (AAN), and Teri Mills, RN, MS, ANP, who seeks to establish an Office of the National Nurse. As a result, by April 19 the PARADE site included an expression of regret that nurses had been included on the list, along with a note that most do have college degrees. Nursing was also removed from the online version of the hot job list. Unfortunately, it appears that there will be no correction in PARADE itself, and we assume relatively few of the people who saw the original item will see the web site clarification. We fear such items will continue to appear and mislead the public as long as there are several paths to nursing entry, and perhaps as long as entry does not require at least a bachelor's degree. But this story does at least show that vigorous advocacy can help nurses address the undervaluation that feeds many of the profession's current problems.

The PARADE item was Lynn Brenner's "How Did You Do?" It was a fairly detailed look at the current job market and outlook, with extensive discussion of salaries, and it included several special items. These included the two boxes: "The Hottest Jobs (No College Degree Required)" and "The Hottest Jobs (For College Grads)." The former included sales representatives, legal secretaries, and "registered nurses." The latter category included jobs like forensic accountant, corporate librarian, and physical therapist. The basic idea most readers will likely get from the description of these two categories is that those in the "no college degree required" category require little or no post-high school training, while those in the "college grads" category probably require a bachelor's degree, though that is not specified. The use of the phrase "for college grads" also implies that the jobs in the other category are not for college grads, that if you have a college degree, you're clearly not going to be pursuing jobs like nursing. Perhaps needless to say, the upper salary ranges listed for the "college grad" jobs are, on average, far higher.

The PARADE web site quickly filled with messages from nurses and others who felt that the description of their profession as not requiring a college degree was misleading and damaging. In addition, on April 17 the AAN's Dr. Burnes Bolton sent a letter arguing that very few nursing jobs do not require college degrees. She went on:

The majority of today's nursing students are enrolled in associate or baccalaureate degree programs. ... [The American Academy of Nursing] believes that the baccalaureate education should be the entry into nursing practice. A growing body of research supports the findings that optimal quality patient care is associated with nurses' educational levels. ...

Americans are living longer. Many older people will have complex health care needs that place enormous demands on nurses. These needs are best met by well-educated nurses, those who have secured baccalaureate degrees and beyond, those best able to use advancing technologies and a complex body of scientific knowledge in the interest of patients under their care. To ensure patient safety and well-being we need to encourage and support higher education for nurses. Your sidebar did just the opposite.

Oregon nurse practitioner Teri Mills sent an e-mail to the magazine on the morning of April 16, the day after the item appeared. Ms. Mills discussed the advanced training that nurses receive, and argued that the magazine's

misunderstanding is one of the reasons that nurses are uniting behind a campaign calling for an Office of the National Nurse on par with the Office of the Surgeon General. The public needs to understand and value what a nurse does, and above all the public is in desperate need of education delivered by a credible and accurate source to prevent the epidemics of diseases that should not be happening in the first place and are bankrupting our healthcare system.

Ms. Mills rightly urged the magazine to publish a correction in the next edition of PARADE.

Unfortunately, the next edition of the magazine contained no such correction, and PARADE has indicated to us that it does not intend to print one, consistent with its usual practice, which the magazine links to its month-long lead time to publication. PARADE has, commendably, at least responded to nurses' concerns. By April 19, nursing had been removed from the "no college degree" category in the online story. (Nursing was not placed in the category "For College Grads.") In addition, the following appeared at the top of the story:

EDITOR'S NOTE: We apologize for the error in the "The Hottest Jobs (No College Degree Required)" box. The copy should have read "personal trainers" not "athletic trainers". We also regret any misunderstanding that may have been caused by the inclusion of registered nurses and dental hygienists in the box. While non-college diploma and certificate programs do exist for these occupations, the majority of RNs and dental hygienists have college degrees and additional levels of training. We appreciate your bringing these matters to our attention.

We appreciate the correction, although many nurses will find the phrase "non-college diploma and certificate programs" inadequate. We doubt that readers will understand from this that nursing diploma programs require three years of rigorous, college-level training; it could be just a brief, basic course, and readers may wonder if most nurses are overeducated for RN work.

One interesting thing is that the magazine might have argued that its use of the phrase "college degree" referred to a bachelor's degree, which is how some people might have taken it, but it did not. Indeed, in the second to the last paragraph of the main article, Brenner says that "not all good jobs require a four-year college degree." She notes that some good opportunities require only an associate's degree or "some kind of vocational training," and cites as an example the job of interpreter/translator--one of the jobs listed along with nursing on the "no college degree required" list." Of course, it is probably easier to note that entry into nursing does not literally require a "college degree" than it is to get into whether the AD is a "college degree," an issue that would involve millions of AD graduates from different fields.

It seems to us that nursing will probably encounter similar distortions from the media as long as there are several different entry paths, with such a wide variance in the type and length of education among its members, and perhaps as long as nursing does not require at least a bachelor's degree. There will probably always be parts of the mass media that will not focus closely on the nuances of just what the different programs require. They will likely see, as PARADE stressed in its editor's note, that some can become nurses without attending a "college." Some may also exclude those without a four-year degree from the category of "college grads," as it seems possible that PARADE itself did. This is not a problem that health professions like physical therapy have, nor that comparable non-health professions like teaching have.

We note that a 2000 JWT Communications study found that private school students thought nursing was too lowly for them. In fact, a friend of ours who is an excellent student at a private high school told us that she would not even have read the list of jobs for which a college degree was "not required," much less considered those careers for herself. The PARADE piece reinforces the idea that nursing is not a career for serious students, even if the "no college degree required" label is technically defensible.

The responses from Dr. Burton and Ms. Mills reflect some of the different aspects of the nursing education issue. The AAN wants the BSN entry requirement, citing research about the association of more education with better patient outcomes, and the need to handle increasingly complex health care problems. Ms. Mills wants the Office of the National Nurse, which would not just address some of the nation's pressing health issues through education, but also show the nation that nursing is indeed "for college grads."

The exchange also says something about the potential and the limits of nursing advocacy in the media. The text of the editor's note on the PARADE site was helpful, but not adequate. In addition, though the PARADE site is probably popular, the note is unlikely to reach most of those who saw the original item. Even a correction in the magazine would likely get past many readers, since far fewer people read corrections than read splashy stories with salary information in the first instance. And even for those who see the note, the effect may not be a complete cure. It's hard to unlearn information, and the note is really just a more nuanced explanation, not something that will really leap out at people.

On the other hand, we were impressed and heartened at the speed and power of the response from nurses. The magazine's reaction makes clear that nurses can shape their own image, at least to some extent. In fact, this kind of advocacy is critical if nurses are to change the way the media and the public values the profession. We have long argued that the kind of undervaluation the PARADE item reflects is a critical factor in many of the problems nurses face, including the lack of adequate clinical and educational resources.

We thank PARADE for at least responding to nurses' concerns, and we salute all the nurses who contacted the magazine.

See the sections "What People Earn" and "How Did You Do?" from the April 15, 2007 issue of PARADE.

Please encourage PARADE to inform its tens of millions of readers about the rigors of nursing education, and how damaging media depictions can discourage adequate funding for the profession's clinical practice, education and research. Please send your comments to PARADE managing editor Dakila Davina at Rebecca_Geroulo@parade.com and copy us at letters@nursingadvocacy.org. Thank you!

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