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Tess Carstensen always wanted to be a nurse. She didn't even consider a two-year degree. She went straight to a four-year program at Russell Sage College in Troy.

"I wanted to be the best nurse I could be," said Carstensen, a 21-year-old senior from the Lake George area. "We have more time to learn how to do it, our skills are better honed and we have more opportunity to learn."

A century ago, nursing students learned their trade by trial and error while working in hospitals. Today, 45 percent of registered nurses have bachelor's degrees, and most have at least an associate degree.

Nationally, there is a growing movement to require all RNs to earn a bachelor's degree, and the profession is looking to New York to be the first state to mandate it.

"New York is really a linchpin here in terms of what will happen in the rest of the country, and I believe if we can pass it there will be a cascading effect of other states following," said Barbara Zittel, the former executive secretary to the state Board for Nursing. Zittel retired so she could lobby for the mandate.

Last year, the Institute for Medicine published a report on the future of nursing that set a goal of increasing the number of baccalaureate nurses to 80 percent by 2020.

The push is on.

One New York hospital, North Shore LIJ, requires newly hired nurses to earn a bachelor's within five years.

Locally, hospitals havve almost completely stopped hiring licensed practical nurses, opting for registered nurses who have at least an associate's degree. Then hospitals urge associate-level RNs to go back to school for a bachelor's.

On Friday, Russell Sage College will announce it is slashing tuition for RNs who want to earn a bachelor's degree. "We asked what can we do as an institution to support the advancement of registered nurses," said Glenda Kelman, chair of nursing at Sage.

This is the school's answer: Instead of $40,000, the program will now cost $24,000.

Sage will also offer on-site courses at St. Peter's Hospital and Glens Falls Hospital.

Glens Falls Hospital and Albany Medical Center have also partnered with Excelsior College in Albany, an online school, to provide courses at a reduced rate -- between $9,000 and $24,000 depending on the student's experience level.

Research has shown that patients fare better when cared for by nurses with higher education levels. According to a 2003 study, for each 10 percent increase in the number of hospital nurses with bachelor's degrees, death rates decrease 5 percent.

In New York, more than half of RNs have bachelor's degrees, slightly higher than the national average.

New York licenses about 8,000 new RNs each year, and 5,000 of them are prepared at the associate-degree level. On average, about 20 percent of associate-degree nurses go on to earn a bachelor's, Zittel said.

Legislation was introduced in the state in 2005 that would have required new nurses to earn a bachelor's degree within 10 years of receiving their nursing license. It would take that long to earn a bachelor's degree if a student took one course a semester. During those 10 years, nurses can practice as RNs.

Currently licensed nurses would not be subject to the law, and even students on the waiting list of nursing schools would be grandfathered.

The Legislature has never voted on the bill, but nursing leaders plan to renew their lobbying efforts. The bill now has the backing of community college leaders, who initially resisted it, Zittel said. Unions still oppose it because they are concerned grandfathered nurses will demand financial assistance for a bachelor's education even though they are allowed to practice without one.

Zittel believes that won't happen based on the experience in pharmacy and physical therapy, which now require doctorates to practice. Most grandfathered practitioners continued to practice at their original education level, she said.

New York has been chosen as a pilot site to implement the recommendations in the IOM report. On Thursday, nursing leaders will gather at the Foundation of New York State Nurses in Guilderland at a conference convened by the NYS Action Coalition. The coalition is funded by a grant from the Robert Wood Johnson Foundation and AARP.

Susan Reinhard, a nurse and senior vice president of policy at AARP, will be a keynote speaker. Reinhard said nurses are taking more responsibility as health care is focusing on preventing illness and reducing hospitalizations.

"Nurses need to be better prepared to do the teaching and the care coordination that is required to help people manage their chronic conditions, rather than getting into a situation where they need to go back into the hospital," Reinhard said. "It's a different skill set that many nurses have been taught or been practicing."

Reach Cathleen F. Crowley at 454-5348 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .