Seamless Academic Progression

‘Research has shown that lower mortality rates, fewer medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate and graduate degree levels.’ [AACN], 2012, ¶ 1) In 2011, one research study published as, Nurse specialty certification, inpatient mortality, and failure to rescue, found that “a 10% increase in hospital proportion of baccalaureate and certified baccalaureate staff nurses, respectively, decreased the odds of adjusted inpatient 30-day mortality by 6% and 2%.” (Kendall-Gallagher, Aiken, Sloane, & Cimiotti, 2011, p. 188) These findings along with other research findings conclude that the competencies between ADN and BSN prepared nurses are different and these differences can greatly affect the outcome of nursing care at the bedside.

I do believe that nursing is in danger of losing its designation as a “profession” if it fails to maintain educational entry levels comparable to those of other health profession. I believe our entry level is far below average when compared to other professions. On a professional level and in this time, entry level should be a baccalaureate degree. Almost every job prefers baccalaureate degree. Nursing entry level being a diploma makes nursing as a profession one may question. This may lead to doubts and patients wanting other professions to better care for them because of the decline in nursing education.

Current trends in healthcare are leading to more complex, advanced patient care and needs. Hospitals and patient services are now in need of highly skilled, trained, and educated professionals to deliver this care. The impact of these trends extend into the profession of nursing, where employers are taking a closer look at the outcomes of patient care delivered by ADN graduates vs. BSN prepared nurses. Although

An ongoing debate for the requirements to become a Registered Nurse (RN) has been unsettled. Several different educational pathways lead to an RN licensure; however, the minimum educational requirements must be standardized at the baccalaureate level for several reasons. Spetz and Bates (2013) published that a growing number of hospitals prefer hiring nurses with a Bachelor Science in Nursing (BSN) as this increases the status of the nursing profession (p. 1). Associate Degree in Nursing (ADN), as well as a certificate on-the-job training Diploma are two other educational pathways to become an RN, which can be disadvantageous to the nursing profession in several ways (Tollick 2013; Spetz and Bates 2013). If entry-level nurses

Nursing has a long history of formal education which moved out of hospitals and into colleges and universities early last century. The associate degree level of nursing was developed out of a need to produce nurses in response to a shortage during and

In addition to the content taught in ADN programs, the humanistic BSN education encompasses more of the physical and social sciences (Impact of Education, 2011). The BSN nurse is better prepared to work more independently, therefore is well qualified to practice in healthcare systems outside of the hospital. Bachelor programs “prepare professional nurse generalists for acute care settings, community-based practice, and beginning leadership /management positions” (Creasia & Friberg, 2011, p. 32). This course of study is crucial to the delivery of good, safe, quality patient care. There have been several research studies completed to see if there is a correlation between higher RN education level and better patient outcomes. Several studies concluded there is decrease in mortality rates within hospitals that employee a greater percentage of bachelor prepared nurses (Creating a More, 2011).

With an ever-increasing body of knowledge in the field of nursing, more education is being required to enter the field of nursing. Many healthcare institutions are raising the educational requirements in order to become employed or maintain employment in their facilities. Healthcare organizations are transitioning to hiring registered nurses (RN) who have a higher level of education, such as, a graduate from a Baccalaureate Degree Nursing (BSN) program. The goal of these institutions is to have nurses with a broader array of skills that can meet the growing demands of our patient population. BSN prepared nurses are recognized for their well-rounded skills in critical thinking, management, case management and health promotion versus Associate Degree nurses (ADN)/Diploma nurses that focus on direct patient care.

As popular as the ADN is today, there is a huge momentum to encourage nurses to receive their BSN instead of an ADN. Nurses that are already entering the workforce at the BSN level are not only more skilled at following and understanding evidenced based practice, but they are also more prepared to go on to school to complete their masters or doctorate degrees. In the changing face of healthcare, more nurses with advanced degrees will be needed to provide primary care as in the role of nurse practitioners. APRNs are going to be in higher demand in community care, public health nursing, evidence based practice, research, and leadership. Shortages of nurses in these positions create a “barrier to advancing the profession and improving the delivery of care to patients” (IOM, 2010, p. 170). Shortages of APRNs and the increasing need for nurse practitioners to provide primary care is why the IOM is recommending to increase the amount of BSN educated nurses entering the workforce to 80% and to double the number of doctorate nurses by 2020 (IOM, 2010, p. 173) The goal to increase the nursing workforce to 80% BSN educated nurses and double the amount of nurses with doctorate degrees is a formidable goal, but increasingly necessary. Patients are becoming more complex inside and outside of the hospital setting with chronic multiple comorbidities. BSN educated nurses are not only better prepared to care for these

According to Creasia (2010), “The first baccalaureate nursing program was established in the United States at the University of Minnesota in 1909” and many programs were 5 years long (p. 4). Today, the BSN program is a 4-year college degree offered at universities, private schools and community colleges throughout our nation. The BSN degree graduate has many advantages over an ADN degree graduate and these might include: career paths that are only open to nurses with a BSN degree including administrative positions and minimum requirement for advanced practice nursing (APN). Furthermore, the BSN graduates get extensive training in components that might include: quality and patient safety, evidence-based practice, information management, clinical prevention/population health, and professional values, all of which are essential as nursing care becomes more complex (Creasia, 2010, p. 4). One of the biggest disadvantages of having a BSN degree is that the legal scope of practice is undifferentiated due to being awarded the same license as an ADN graduate “hindering the reward system for leadership responsibilities” (Creasia, 2010, p. 16).

The Carnegie Foundation reports that nurses today “are undereducated for the demands of practice” (Benner, Sutphen, Leonard, & Day, 2009, ¶ 17). Education of the ADN centers around the hands-on skills needed to care for a patient at bedside and less on the scientific theories that allow the holistic treatment of a patient. A report by the Milbank Memorial Fund in 2001 reports that nurses educated at the ADN level have a higher incidence of mistakes made while performing their duties (Rosseter, 2011, ¶ 24). Registered nurses who graduate with the two year degree lack research skills, leadership and managerial skills as well as informatics needed to deliver quality medical care within today’s health care system (Orsolini-Hain & Waters, 2009, p. 269).

The report indicates, of the overall nurses employed in healthcare, 80% of the nurses will have a baccalaureate degree by the year 2020. The baccalaureate and graduate nursing programs prepare nurses thoroughly so that they will have significant knowledge,

The implications for BSN-prepared nurses in addition to those of RNs with an associate degree

(Friberg 26) When ADN programs were started they were only meant to be short term. If a nurse had ADN they were team up with and BSN nurse. In the past the ADN degree was used for nursing shortage, they need nurses. Not to say that having an ADN is a not expectable. As the federal, state and many hospitals combine together the percentage and numbers of how the nurse caring for patient should have a higher education. I have an Associate degree. I have been a floor nurse for about five year. Our hospital became Magnet in 2011, with this award we have to have certain percentage of bachelors’ nurses by next designation. This is not why I am getting my bachelors to be a percentage but to have more windows of opportunities in having my BSN. I am planning on continuing on to get my Masters.

There is an increasingly high demand for students going into nursing careers in our society, but there are also varying educational pathways for these students to get into these careers. Are the three educational pathways (Diploma, Associate Degree, and Baccalaureate Degree) preparing prospective nurses to be at the same competency level after schooling? Advancement in education has become an increasingly important topic amongst health care organizations. Educational preparation can indeed affect nursing care and the decision making of nurses. In this paper, an analysis of nursing history and the degree programs themselves will provide evidence of an increased level of patient care by BSN nurses vs. ADN nurses.

“Throughout the last decade, policymakers and practice leaders have recognized that education makes a difference” (Impact of Education, n.d.). Hospitals are also trending towards preferred hiring of bachelors prepared nurses for their workforce. Even national organizations are jumping on the bandwagon requiring “all nurse managers and nurse leaders to hold a baccalaureate or graduate degree in nursing by 2013” (Impact of Education, n.d.), likewise the Institute of Medicine has also recommended that all hospitals have at least 80% of their nursing staff with a BSN or higher by the year 2020 (Impact of Education, n.d.).