How students pursuing nursing education face systemic challenges

Schools say demand is exceeding the number of program seats available

(Kristen Frier)

When Diana Larios was a kid, she loved playing doctor. Now, as an adult, Larios works in the medical field, chasing a dream of becoming a registered nurse during a time when the province is experiencing significant shortages.

Larios graduated high school in 2016 and went straight to Douglas College. There, she enrolled in the Academic Foundations for Potential Nursing Applicants, or AFNURS. The one-year, 30 credit program is for students who want to pursue a Bachelor of Science in Nursing, and Larios completed it by the end of 2017 before applying for the BSN program.

“But I didn’t hear back at all,” she says. 

Larios kept applying to Douglas College and a few other institutions like Langara, the British Columbia Institute of Technology, University of the Fraser Valley, University of British Columbia, and Kwantlen Polytechnic University. 

“At the end of 2018, I stopped applying, and I was just like, ‘this is ridiculous,’” she says.

One of the most challenging parts for Larios to understand was why she never heard back from the institutions despite having a good GPA and meeting the required volunteer hours. Larios remembers when she was back in the AFNURS program, when her friend got into the BSN program, and she didn’t. 

“We had similar grades. We had a similar experience and volunteering hours because that’s also a factor … I thought getting good grades would guarantee a spot. But it turns out it does not,” she says. “So it’s just very frustrating that you don’t know what they’re looking for.” 

At Douglas, if students are not accepted into the AFNURS program, Larios says they usually struggle to get into the BSN since it gives priority admission to students who went through the foundation program. Due to the program’s high demand, the Douglas admissions requirements website even says that “students are encouraged to consider a second choice of academic program or path in the event that seats are not available in the BSN program.”

“Other people who weren’t in that program but still want to pursue nursing, they would have to wait like two or three semesters in order to take a prerequisite course,” says Larios, who eventually applied to the Practical Nursing program at Stenberg College instead, and later graduated with a Licensed Practical Nurse Diploma. 

Until 2019, KPU had a similar program to AFNURS called the Health Foundations Certificate. Students seeking to pursue a BSN or the Bachelor’s in Psychiatric Nursing had to take the 32-credit Health Foundation as a prerequisite requirement. 

In 2019, the CBC published interviews with former KPU students who called the program a “cash grab,” saying it was unfair that such high numbers of students would be accepted with such few seats available.

During 2018 and 2019, the program admitted 594 students, even though there were only 104 seats in the BSN and BPN programs. The program was then “postponed indefinitely,” and in an email statement to The Runner, Sharmen Lee, dean of the KPU Faculty of Health wrote, “From Summer 2019 on, we have had no new intake of students into Health Foundations.”

KPU is currently working to change the requirements for new BSN and BPN applicants for fall 2022. 

“Essentially, we are unbundling from the Health Foundations program the courses required to apply for the competitive admission process for nursing,” Lee wrote. 

With this, they hope to give students the flexibility to use their KPU course credits for alternative options if they can’t be accepted into one of the nursing programs. According to Lee, these changes won’t be able to affect the number of nursing students they can take at KPU.

“KPU is dependent on funding from the Province of British Columbia to provide seats in nursing programs, and we’re in regular dialogue with the Province about how we can support the delivery of education opportunities to meet the needs of the health sector in B.C.,” she wrote. 

In each academic year, there are two intakes into the BSN program of 32 students each and one intake into the Bachelor of Psychiatric Nursing program of 40 students.

Educators are asking if one of the contributing factors to B.C.’s nursing shortage could be the lack of available spaces to train new nurses who can replace those leaving the workforce. But many of these programs have long waiting lists — some Douglas applicants reported having to wait for a year and-a-half — and require foundation certificates that do not guarantee entrance into the nursing schools.

In return, the Ministry of Advanced Education says that they are working on opening more seats for future students.

“…We know there is a need for more health care professionals, such as nurses, in post-secondary in communities across the province. We also know that there is a high demand for a Bachelor of Science in Nursing at most post-secondary institutions,” wrote a ministry spokesperson in an email to The Runner.

“B.C.’s public post-secondary institutions currently offer seats for just over 2,000 students annually in Practical Nursing, Bachelor of Science in Nursing, Bachelor of Psychiatric Nursing, and Nurse Practitioner programs.”

The government is funding 500 new nursing seats over the next three years to train more healthcare workers, and this will include reviewing proposals from all nursing programs in B.C., including KPU.

To students who are waiting to move on with their career, two thousand seats does not seem to be enough. Not only do the long waiting times impact students’ personal decisions and finances, but they also impact the hospitals where registered nurses are needed the most. 

In an interview with News1130, Elizabeth Saewyc, director at the School of Nursing at UBC, said the school has 120 seats in their BSN program. This year they received 860 applications from prospective nursing students.

Not only are there not enough seats to meet demand, but for current nursing students, Saewyc said that there aren’t enough spaces for clinical placements that give students the necessary hands-on work experience.

Larios, who now works at Langley Memorial Hospital, says that this can have an impact on nurses’ workloads later in their careers. As a certified LPN, she says she has noticed that there are some tasks that only registered nurses can do because they have the extended education. 

“If an RN were to call in sick, it would just be one around on the floor. And if one of our patients were to get worse throughout the night, that’s when we don’t really have too much support in the hospital,” she says. “And it’s more workload on that one [RN] because there’s only so much we can do.” 

In her time working at the hospital, Larios says she has seen a greater need for RNs and that many of them are calling in sick due to burnout. 

“Our workload is so heavy that people just need a mental health day. You know, people are tired. They just need a day off.”

Just like Larios, Veronica Wattenyad has also faced challenges trying to make it through nursing education. She went to Douglas in the fall of 2016 intending on completing the BSN program, and was able to finish the AFNURS certificate, but after doing more research into other institutions, she says she found the BCIT nursing program more appealing, and was later able to transfer her credits from Douglas.

“The classes would get so full so quick, and I would have to wait like two semesters just to get in,” she says.  

When Wattenyad was younger, she would share her candy popsicles with all the kids in the playground, and when her grandma was still alive, she would help her move around in her wheelchair. That’s when she noticed she enjoyed caring for people, and made it her goal to pursue nursing.

“I looked up the prerequisites for nursing at BCIT, and it was way easier than Douglas. So I tried applying there this past year, but I didn’t get it,” says Wattenyad. “Every school has different requirements. It’s just insane.”

Douglas recommends that students complete a one-year foundations certificate before going into their BSN. At Langara, students also need to take a similar mandatory program called the Foundations in Health Studies program before entering a BSN. But Douglas’ one-year foundation program, the Foundation in Health Studies from Langara is a minimum of two semesters. 

At BCIT the admission requirements for the BSN program include high school math, chemistry, and 18 selected post-secondary credits with a minimum of 67 per cent, a personal characteristics assessment, and a mandatory applicant questionnaire. 

At UBC, the admission requirements include 48 non-nursing university credits. Vancouver Community College accepts applicants into nursing with 18 credits from their selected first-year level university courses. 

There are a few institutions in B.C. that only require high school prerequisites. These are Camosun College with the University of Victoria, which require credits and grades from completed high school or Adult Basic Education programs. The length of the program is 2.5 years at Camosun College then 1.5 years at the University of Victoria. 

Thompson River University is revising its admissions processes, but as of now they only require high school courses and a letter of introduction. Trinity Western University requires acceptance to TWU as an undergraduate student, high school prerequisites, a nursing application, references, and a Computer-Based Assessment for Sampling Personal Characteristics, or “CASPer” test. Several nursing programs require that students take this test, including KPU.

The University of the Fraser Valley requires completion of their selected high school courses with a minimum grade of C+ within five years prior to enrollment. Other entrance requirements include volunteer experience in a healthcare setting or employment in a healthcare field, a health assessment indicating fitness to practice, attendance at a program information session with the program faculty, and an interview with faculty members.

Vancouver Island University’s requirements for their BSN program are selected high school courses completed with a minimum of C+ and the completion of a CASPer test.

In British Columbia, if institutions want to have a recognized BSN program, they must first go through the British Columbia College of Nurses and Midwives.

In order to change parts of their BSN program, institutions have to notify the BCCNM through writing of any proposed substantial changes. Some of these changes can include “the length of a course, learning resources and infrastructure, collaboration with other institutions, changes to admission requirements or program completion requirements.” 

“Educational institutions can determine how they structure their education programs (i.e., having an “initial foundations program” prior to entering the nursing program),” wrote the BCCNM education program review director in an email to The Runner regarding institutional requirements.

“BCCNM does not have a role in how education programs choose to structure their nursing education programs. These decisions are made by the institution,” they add. 

People who are applying for nursing programs in B.C. often have to spend time comparing all of the different requirements for each school. When Larios began to study for her LPN diploma, she says an instructor asked the class why they decided to become LPNs. 

“Everyone had the same sob story that they were tired of waiting for a BSN program, and that’s why they were here,” Larios says. “It’s just about luck … it’s frustrating.”