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Competency Differences in Nursing Education levels

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During the Crimean war (1853 to 1856), Florence nightingale experienced the positive impact that a trained nurse can have on patient care. Her experience lead to her creating the nightingale training school for nurses at St. Thomas‘s hospital in London in 1860. The nursing education model she advocated for was based on apprenticeship, where women were trained in hospitals.

The nightingale model of apprenticeship was adopted by the American women who had nursed the sick soldiers during the civil war and realized the effectiveness that trained nurses had. 2 to 3 year nurse training schools were started in hospital which was credited with providing knowledge and skills to women as, “trained nurses” who helped reform the care of the sick, though there were problem associated with the model. (Creasia and Friberg, 2010, p.4) notes that “the apprenticeship model of nursing advocated by nightingale provided physicians and hospitals with an inexpensive and skilled workforce.” But Creasia and Friberg, (2010) also observes that, “obedience to the physician and long days on wards did not create an environment conducive to learning nor did it promote nursing as a profession”. (P. 5).

Baccalaureate Degree (BSN)

The baccalaureate program is a four year program that is offered by universities. According to (Creasia and Friberg, 2010, p.11 ) , “baccalaureate program was based on the premise that nursing concepts pertinent to acute illness, the psychosocial dimensions of illness, and public health principles were essential to professional nurses”. The financial cost and long duration of the program proved to be a big huddle for many women could not get into the program. This in turn led to shortage of nurse during and after World War II due to the baby boomer population.

Associate Degree in Nursing (ADN)

In 1951 nurse educator Mildred Montag, “proposed a new program to prepare nurse technician in a 2 year associate degree (AD) community colleges” (Cresia and Friberg, 2010, p.15). The ADN programs are focused on training nurses for clinical skills and basic nurse practices. The ADN programs had a lot of success as it minimized the shortage of nurse and increased the entry level options that lead to registered nurse licensure and beginning positions.

Differences in BSN and ADN

There are many differences between the baccalaureate degree and Associate Degree program like the cost and duration of the programs but the difference in competencies more explained by the focus of the course work. Because of the duration of the ADN program, nursing students mostly have time to concentrate on skills, bedside care, patient monitoring and medication administration. While in the BSN program, students learn skills like the ADN but also knowledge on research, critical thinking, professionalism, leadership and also management. BSN nurses also have more room for growth in their career and take up more managerial jobs like nurse managers, administration duties and teaching.

Both BSN and ADN sit for the NCLEX upon completion of their programs but as (Rosseter, 2013, p.1) writes “The fact that new nurses pass the licensing exam at the same rate does not mean that all entry-level nurses are equally prepared for practice. The NCLEX tests for minimum technical competency for safe entry into basic nursing practice. Passing rates should be high across all programs preparing new nurses. This exam does not test for differences between graduates of different programs, measure performance over time, or test for all of the knowledge and skills developed through a baccalaureate program.”

Research has shown that hospitals that have implemented the policy of increasing the BSN level nurses have better patient care outcome and have reduced the mortality rates. According to ( Rosseter, 2013, p.2) “In an article published in the March 2013 issue of Health Affairs, nurse researcher Ann Kutney-Lee and colleagues found that a 10-point increase in the percentage of nurses holding a BSN within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients—and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients.”

Patient care situation

A 78 year old male presented to a medical surgical unit post day one of open reduction internal fixation to the left hip. Patient has staples and a wound vacuum on the surgical site. Patient remains non -weight bearing to the left leg. Patient is experiencing lots of pain and is moaning and groaning. The RN assigned will concentrate more on bedside care, medication management and implementing the core measures while the BSN will initiate interim plan of care which will involve, identifying patient problems identified during admission and hospitalization ,expected outcomes and interventions to help patient and family to achieve expected outcomes. The BSN will also emphasize teaching on the disease process, activity limitations and also provide learning resources for further information and support.
Although both ADN and BSN level of nurse differ in various perceptive, they all embrace the four major components of the metaparadigm of nursing.


Creasia, L.J , Friberg, E (2013). Conceptual Foundations: The Bridge to professional Nursing practice (5th ed).
Rosseter,J. R. (2013). Creating a More Highly Qualified Nursing Workforce. (AACN).Retrieved 5/11/2014 from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf

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