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Volume 42, No. 1 Summer 2020Employment Trends, Loan Debt, and New Graduates’ FutureEducation Plans: The Pre-Pandemic Class of 2019Veronica Feeg and Diane J. MancinoAs the overall economy in theUnited States continued toimprove since the early days of2009, the annual survey of the NationalStudent Nurses’ Association (NSNA) hasreported on the growth of registerednurse (RN) employment and associatedtrends over the past 10 years. The 2018results showed increases in employmentof RN graduates from all programs continued – including associate degree graduates – which is good news for students(Feeg & Mancino, 2019). However, withinthose increases were potentially troubling signs of continued debt and reluctance to pursue advanced education.These trends continued for the graduating class of 2019.The results of the New GraduateAnnual Survey for the graduating class of2019 (approximately 6-12 months postgraduation) provides a snapshot in timeabout employment, workforce trends,and loan debt for a cohort of new nursesthat will undoubtedly vary for future newgraduates following the unprecedentedchanges caused by the COVID-19 pandemic. The relevance of these findingswill be critical in identifying a baselineupon which the impact of rapid deployment of graduating seniors in 2020 andthe swiftly executed sweeping changesin nursing education will be compared inyears to come. The year 2020 – “Year ofthe Nurse and the Midwife” and “Year ofCoronavirus” – has collided into a landscape of workforce sea changes yet to beunderstood. Nonetheless, the AnnualNSNA New Graduate Survey snapshot intime remains relevant. What were thetrends in new graduate employment preCOVID-19 and was loan debt a continuing problem?Veronica Feeg, PhD, RN, FAANDiane J. Mancino, EdD, RN, CAE, FAANBackground: COVID-19 Impacton NSNA StudentsAs nursing education across theUnited States entered spring of 2020,massive mandatory closures happened.Nursing schools everywhere were toldon short notice to close campuses andimmediately change the delivery of education to remote and simulation learning. In response to understanding howthis affected NSNA members, a surveywas conducted to seek answers to frequently asked questions (FAQs) abouthow nursing students had experiencedalternative learning activities during theCOVID-19 social distancing period inMarch and April 2020. The survey wasVolume 42, No. 1 Summer 2020designed and reviewed by the chiefexecutive in the organization andresearcher/nursing education expert toelicit responses to questions using thecommon ‘2-minute’ questionnaire stylemembers of NSNA frequently answer.The questions included backgroundinformation from the respondents andclosed-ended choice questions aboutseveral aspects of online, clinical, andsimulation experiences. The responsesincluded complete data on most itemsfrom 1,885 nursing students who arecurrent members of NSNA, from almostall 56 state and regional memberships,with 63% of more than 10 responses perstate, and only three state and regionswith no responses (Delaware, AmericanSamoa, and Northern Marianas Islands).Student pre-graduation work wasclearly different than the past. Inresponse to how the current spring 2020semester has changed due to the pandemic, 75% of the students reportedtheir academic activities have beenmoved to online formats and 31%described a variety of ‘other’ offeringsincluding: class and clinical simulations,virtual clinicals, case studies, and waitingfor online courses or clinicals – orVeronica Feeg, PhD, RN, FAAN, is AssociateDean, Molloy College, Rockville Centre, NY.She is also Director of the Center for NursingResearch and Evaluation, providing consultation to community partners including NSNA.Diane J. Mancino, EdD, RN, CAE, FAAN, isExecutive Director, National Student Nurses’Association and the Foundation of the NSNA.She may be contacted at nsna@nsna.org,with “Attention Diane Mancino” in the subjectline.1

Figure 1A.Clinical Options Pre-COVID-19Clinical Options used by your school during the spring 2020 semester prior to theCOVID-19 pandemic include (check all that apply):100%Responses80%60%40%20%0%Direct ne/virtual)Written case studiesor clinical groupstudiesFigure 1B.Clinical Options Post-COVID-19Clinical options now used by your school following the outbreak of theCOVID-19 pandemic include (check all that online/virtual)Written casestudies orclinical groupcase studiesClinical canceledthis semesterdue to pandemic(simulation, casestudies, directpatient contact)0.95%73.90%61.27%24.19%Volume 42, No. 1 Summer 2020Clinical time inclinical settingas paidVolunteer time in employee (i.e.clinicalstudent nursesetting istechnician;counted towards certified nursingclinical hours byassistant)my schoolis countedtoward clinicalhours by myschool2.81%1.33%Other(pleasespecify)7.90%

Figure 2.Employment Rates by Regions of the Country for the Past 10 rtheastCentralFigure 3.Employment by Types of Educational Programs 2017-201992%90%88%86%84%82%80%201720182019Q7: Associate degree (ADN)87%87%84%Q7: Baccalaureate degree (BSN pre-licensure)91%91%90%Q7: Accelerated BSN program (pre-licensure)85%88%84%Q7: Associate degree (ADN)Q7: Baccalaureate degree (BSN pre-licensure)Volume 42, No. 1 Summer 2020Q7: Accelerated BSN program (pre-licensure)3

Figure 4A.Overall Employment Rates by Types of Schools (Public, Private, ic89%89%87%Private (not-for-profit)88%89%88%Private (for-profit)84%88%83%PublicPrivate (not-for-profit)Private (for-profit)Figure 4B.Regional Employment Rates by Types of Schools (Public, Private, stCentralPublic92%76%87%95%Private (not-for-profit)92%83%83%96%Private (for-profit)86%81%76%92%Public4Private (not-for-profit)Private (for-profit)Volume 42, No. 1 Summer 2020

Figure 5.Comparisons 2014 and 2019 Responses of Continuing BSN/MS EducationQuestion: If you graduated with an associate degree or from a diploma school of nursing and you are planning to purse anRN to BSN or RN to MSN, when will you enroll?40%35%30%25%20%15%10%5%0%CurrentlyEnrolled (Fall)SpringNext FallIn 2 YearsIn 3 Years2014In 4 YearsAfter 5 Years No Plans toContinueUnsure2019Figure 6.Loan Debt by Type of Nursing Program 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 Associate Degree(ADN)BaccalaureateDegree(BSN pre-licensuretraditional program)Accelerated BSNProgram(pre-licensure)Master’s DirectEntry Degree(pre-licensuredirect entrymasters)Volume 42, No. 1 Summer 2020Clinical NurseLeader MastersDirect Entry(pre-licensuredirect entrymasters)RN to BSN(post-licensure)5

Figure 7.Loan Debt by Types of Schools (Public, Private, Proprietary) 50,000 45,000 40,000Average Debt 28,967 35,000 30,000 25,000 20,000 15,000 10,000 5,000 Public(Examples: state collegesand state universities;community colleges)delayed indefinitely. In response to howclinical experiences were being implemented for spring 2020 prior to (and following) the COVID-19 pandemic, students selected a combination of optionspre- and post- that were clearly different(see Figure 1A and Figure 1B). Less than10% reported simulation/patient care as50%/50%. In some cases (other typed indescriptions) students responded that100% was simulation or virtual, withvery few responding that 90-100% waspatient care only.New Nurses: GraduatesFrom 2019Consecutive data collection of newRN graduates from the NSNA surveyreported over the past years providesinsight into RN workforce and trends innursing education, loan debt, and plansfor additional education by nursing students. Clearly, these past trends may beimpacted on the post-COVID-19 ‘Class of2020’ but, prior to this, employmentdemonstrated (over the past 10 years) acontinuous upward movement or stableevidence of new graduates finding jobsand employment opportunities in all6PrivateNot-For-Profit(Examples: New YorkUniversity, VillanovaUniversity, DrexelUniversity, etc.)ProprietaryFor-Profit(Examples: ChamberlainCollege; University ofPhoenix; Fortis;Rasmussen; Keiser; etc.)areas of the country until this year; downoverall from 2018 (89%) to (87%) in2019, with a slightly downward trend allbut the central region of the country (seeFigure 2). If the trend indicates an emerging trend about employment, the class of2020 – who were catapulted into practice quickly – and those students behindthem who are experiencing more simulation-based education, may have a different employment experience than wehave seen before 2019.Breaking this down by types of programs, it appears that associate degreenurse (ADN) graduates were finding itmore difficult to find employment (seeFigure 3) (p 0.05) in 2019 compared toprevious years, and baccalaureatedegree nurses (BSN) employment rateswere higher than other types of programs.To further explore how employmentchanged by types of schools (public, private [not-for-profit], and proprietary [forprofit]), findings suggest with the overalldecrease in employment rates in 2019,especially regionally other than the central region, employment in all types ofschools decreased from 2019 with theVolume 42, No. 1 Summer 2020Overall Debtwidest drop in proprietary schools (seeFigure 4A). This was also remarkable andvaried by regions for 2019 (see Figure 4B)with low rates (76%) for public schools inthe West. These differences suggest theremay be differences in numbers of different types of schools responding byregions and the job market saturationimpacts the West public schools evenmore than the other types of schools.The Impact of Loan Debt onFuture Education PlansWith the ongoing policy discussionsabout the burden of loan debt, it wasimportant this year to examine thedetails about program choice and hownursing student loan debt may impactprogression or continuation in nursingeducation. Does program type impactamount of loan debt and does loan debtinfluence students’ plans to further theirnursing education? These are importantquestions to raise with the nationalfocus on student loan debt burden.One focus was on whether or notADN nurses planned to pursue highereducation in general, and what plansall new graduates have in advanced