Associate-Degree Level vs Baccalaureate-Degree Level in Nursing

The first step in becoming an RN is to attend a college degree program that has been accredited by the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE). In the United States, upon graduating from an accredited nursing program, nursing school graduates are allowed to practice as Registered Nurses after passing the National Council Licensure Examination, most commonly known as the NCLEX. The NCLEX passing standards represents “minimum assessed competency for safe and effective entry level practice” (Brown, Wend, Halsey & Farwell, 2012). However, a general high level of safety is expected across all levels of nursing practice.

Controversy amongst the nursing profession has been developing for well over 10 years in regards to which nursing education should be the acceptable minimum standard preparation for an entry level position in nursing practice. The nursing educations that will be discussed are the associate-degree nursing education (ASN) and the baccalaureate-degree nursing education (BSN). A competency is described as “an expected level of performance that integrates knowledge, skills, abilities, and judgment” (American Nurses Association, 2008). To understand the differences in competencies between the two levels in nursing, the educational requirements for the two will need to be explored.

The ASN is offered by community and junior colleges and usually takes about two to three years to complete. The associate curriculum focuses on the technical aspects of nursing allowing for the ASN nurse to provide direct, hands-on patient care in a structured health care setting, such as hospitals, clinics and private practice. Some argue that the nurse with the ASN level is task oriented, has only developed hands on skills and can even foster poor patient outcomes (Moorhead & Cowen, 2006). ASN programs do not prepare nurses for professional development through graduate study or to further their nursing career. Why go through an ASN program if it carries many limitations? During the World War II, the demand for nurses was on the rise and the ASN was created to produce more nurses to meet this demand. In summary, the ASN programs offers a shortcut for nurses to acquire the necessary minimal skill set to obtain licensure and practice safe entry level nursing, without the emphasis on leadership, nursing theory, and critical thinking.

The BSN is offered by colleges and universities and takes about four years to complete. The baccalaureate curriculum emphasizes leadership, nursing theory, problem solving and critical decision making and managerial skills along with the provision of technical nursing skills and knowledge. The Texas Board of Nursing lists specific content areas for the BSN program as research, community and leadership. The BSN course allows for nursing students to make crucial decisions in patient care. Nurses with a BSN have an understanding of culture and society and are “prized for their skills in critical thinking, leadership, case management, and health promotion and for their ability to practice across a variety of inpatient and outpatient settings” (AACN, 2006). BSN nurses can analyze and make recommendations for treatment because the BSN nurse is thought to be whole rounded and well informed compared to an AND nurse (Henderson, 2010). In short, BSN programs take longer to attain and include the entire curriculum of the ASN program along with extensive treatment of the physical and social sciences, the humanities, nursing research, community health, management and leadership.

The first major difference between the BSN and ASN prepared RN is the length of their education. The nurse’s scope of practice defines the extent of the provision of care within each level of educational preparation (Texas Board of Nursing, 2011). The second major difference is the patient. The patients for the ASN prepared RN are individuals and their families, whereas the patients for the BSN prepared RN are individuals, families and the public. BSN and ASN nurses have the same technical nursing skill knowledge and are both prepared for the NCLEX-RN and upon passing, entry level nursing practice.

The BSN prepared RN (BSN-RN) is able to approach patient care with a holistic view of the patient; caring for the four metaparadigms in nursing: person, environment, health & illness and nursing. The BSN-RN may be able to question the medical prescriptions and treatments ordered by a doctor if they seem inappropriate. after considering these concepts. For example, 4th PARAGRAPH: Patient care/approach examples from the BSN vs ASN Concept Theory: manipulating environment to produce desireable outcomes for patient care. We the nurses are apart of the patients environment so by “manipulating” the environment, requiring nurses to have higher level of ed, we can bring about positive outcomes.

Patient care example: BSN nurse was more capable of predicting patient outcomes and understanding pathophysiology and etiology

The need for the BSN prepared RN in the nursing field is apparent through evidence-based recommendations and studies. A 2008 study conducted by California Institute for Nursing & Health Care (CINHC) calls for the transformation of California’s nursing education system. The study director, Dr. Jan Boller said: “Recent studies clearly demonstrate that a higher prevalence of baccalaureate- and masters-prepared RNs at the bedside positively impact patient outcomes.” The additional course work enhances the student’s professional development, prepares the new nurse for a broader scope of practice, and provides the nurse with a better understanding of the cultural, political, economic, and social issues that affect patients and influence health care delivery

6th PARAGRAPH: Why are the requirements changing to BSN? Proof in pudding, refer to studies, reports that support reasoning for BSN degrees : Example of BSN teaching abilities “Table 2 shows the distribution of nurse characteristics and nurse reports overall and across the 3 categories of hospitals by type of practice environment. Overall, 6% of the 10,184 nurses in our sample were men, the average age was 40 years, and the average number of years working as a nurse was approximately 14 years. Approximately 1 of 3 nurses (31%) worked on medical/surgical units, and 18% worked on intensive care units. Forty percent of the nurses had bachelor’s degrees or higher, 35% held diplomas, and 25 had associate degrees as their highest credentials in nursing. Breaking down the nurses by type of hospitals, higher percentages of the nurses in hospitals with poor care environments reported high burnout levels and dissatisfaction with their jobs.

The percentage of nurses who reported that the quality of care was poor or fair (rather than good or excellent) was twice as high in hospitals with poor care environments as in hospitals with better ones. A similar pattern was observed with respect to the likelihood of nurses lacking confidence that patient care problems would be resolved by management and that their patients were able to manage their own care at discharge. Higher proportions of those in the hospitals with poor and mixed environments were unwilling to recommend their hospital to a family member” According to the article : Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes it seems reasonable to assume that the actual number of patient deaths that could be averted annually by improved care environments, nurse staffing, and nurse education is somewhere in the range of 40,000 per year.

The analyses reported here suggest that nurse leaders have at least 3 major options for improving nurse retention and patient outcomes: improving RN staffing, moving to a more educated nurse workforce, and improving the care environment In this study, we are able to demonstrate that hospitals with even some of the features of magnet hospitals (investments in staff development, quality management, frontline manager supervisory ability, and good relations with physicians) are associated with better nurse and patient outcomes. Our findings show that each of the 3 options for improving outcomes-improving nurse staffing, education, and the care environment-contributes independently to better patient outcomes, and maximizing all 3 would seem to hold the greatest promise for achieving the best outcomes.

In the interest of providing the best patient care and leadership by its nurse corps officers, the U.S. Army, U.S. Navy and U.S. Air Force all
require the baccalaureate degree to practice as an active duty Registered Nurse. Commissioned officers within the U.S. Public Health Service must also be baccalaureate-prepared. To fulfill our shared goal to prepare a robust nursing workforce, the undersigned organizations acknowledge our full support of academic progression for nursing students and graduates. Community college presidents, boards, and program administrators are aligned with the nation’s nursing association leaders in the belief that every nursing student and nurse deserves the opportunity to pursue academic career growth and development.

It is through the collaboration and partnering of our various organizations that we can facilitate and inspire the seamless academic progression of nursing students and nurses. Our common goal is a well educated, diverse nursing workforce to advance the nation’s health. The shift is gradual but unmistakable; the Veterans Administration and other institutions are requiring that registered nurses possess a BSN degree (at minimum). Although the debate has continued for decades, the nursing community finally seems to be reaching a consensus. The student who aspires to become a nurse should anticipate a nursing education that culminates with at least a bachelor’s degree. According to studies, controversy notwithstanding, the patient who receives care from a registered nurse with a BSN is the safer patient.