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Difference in Competencies; ADN vs BSN

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The definition of competency as described by Gurvis and Grey is “an individual’s actual performance in particular situation, described by how well the individual integrates knowledge, attitudes, skills and behavior in delivering care according to expectations”(Gurvis& Grey,1995). The purpose of this paper is to describe the difference in competencies between the associate level and bachelor level education in nursing. It will provide a rational for the need of increased educational levels of nurses in the workforce. There have been many studies to prove that an increase in the level of nursing education leads to an increase in patient outcomes. It was said to be difficult to find an efficient way to use statistical data throughout the scope of the nursing practice. For this reason these studies were based primarily on patient outcomes, mortality rates and failure-to-react during complications after surgery.

These studies have shown that “In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patient’s experienced lower mortality and failure-to-rescue rates.”(Aiken, 2003) In another study it was found that a “10% increase in proportion of BSN nurses to be associated with a 5% decrease in the likelihood of failure-to-rescue” (Ridley, 2008). This is among the multitudes of different studies as shown in the American Association of College of Nursing’s fact sheet “Creating a More Highly Qualified Nursing Workforce” which revealed that mortality rates decrease as the level of nurses education increases.

Each segment under the “Research Linking Nursing Education to Patient Outcomes” shows again and again that the bachelor prepared nurses improve patient outcomes. (Rosseter, 2013) These studies prompt the question of “What are the differences in competencies between the associate and the baccalaureate degrees”. According to the National League for Nursing the competencies differ only minimally. They have subdivided the competency categories into four groups: Human flourishing, nursing judgment, professional identity, and spirit of inquiry (2013). With regards to human flourishing the associates level nurse (ADN), advocates for the patient and encourages them to educate themselves and continue to grow as humans. The bachelor nurse (BSN), uses the words “incorporate the knowledge and skills” (NLN, 2014) to help patients, but also includes the word “community” that the ADN omits.

Both competencies are similar to each other in that they both with educate the patient and push for continued patient growth as a human. (NLN, 2014) The next category was Nursing Judgment. The ADN uses nursing science to provide care and promote health in both the family unit and in the community. The BSN will make judgments based on “nursing science and knowledge form other disciplines” (NLN, 2014) to provide care. The difference here is the use of the knowledge from other disciplines. This indicates that with higher education the nurse with incorporate either a learned or a research skill into nursing judgments, and seek out the other disciplines in the hospital to collaborate with before making a decision with regards to the patients care. Professional identity was the third category in the competencies.

Both the ADN and the BSN state that they are to assume the role “as a nurse through actions that reflect integrity, commitment to evidence-based practice, caring, advocacy, and safe care” (NLN, 2014). The BSN will also assume the role as a leader to improve patient care. The last category is Spirit of Inquiry. This was the only category where the difference in degrees was apparent. The ADN will question that which does not seem appropriate, and will use critical thinking skills to create a new insight into a possible solution. The BSN will incorporate research to create a possible change to solve the same problem. An example of how a BSN nurse would care differently for a patient as opposed to an ADN would be in a situation involving a hypertensive patient. If the patient is on the telemetry monitor and their heart rate and blood pressure begins to increase a red flag will go up for the nurse to assess the patient.

Upon entering the room an ADN nurse may manually take the blood pressure, and if it the reading was truly an increased blood pressure then the ADN nurse would most likely administer a blood pressure medication as per the physician’s orders. The BSN in the same scenario will inquire further to determine the cause for the increase, thus taking their critical thinking skills to the next level. In doing so, the BSN will find that the patient just had an argument with a family member after having a cup of tea, both of which would increase one’s blood pressure and heart rate. The BSN may attempt to holistically reduce the blood pressure through relaxation techniques, before simply administering medication. They would also realize that by administer the medication, when the patient had a chance to calm down the patient my actually bottom out, and your left with a hypotensive crisis.

This example shows how the education of the ADN is such that they are knowledgeable and can fix the problem at hand, but the BSN would take their critical thinking skills further trying to find the cause of the problem. After reviewing the difference in the competencies, it is concluded that there are differences between the ADN and BSN. The real difference with furthered education is leadership skills and the additional skill of using researching to lead change. At the entry level position there is not much difference between the ADN and the BSN. However, because of the different coursework “the BSN programs provide nurses an expanded world view and increased critical thinking skills.” (Starr, 2010).

These increased skills are exemplified by increased patient outcomes. Other advantages in obtaining the BSN is that it creates an increased ability advance in their nursing career. Nurses have a large presence in the health care system, and play a huge role in patient care and outcomes. With increased education nurses are able to expand on their knowledge and are able to have voice in the health care system among the other professional disciplines.

Smith, J.E. PhD, RN (November 2002) Analysis of Differences in Entry-Level RN Practice by Educational Preparation. Journal of Nursing Education, 41(11), p.491-494 National league of nursing (2013) Competencies for Graduates of Associates Programs. Retrieved from: http://www.nln.org/facultyprograms/competencies/comp_ad_dp.htm National league of nursing (2013) Competencies for Graduates of Baccalaureate Programs. Retrieved from: http://www.nln.org/facultyprograms/competencies/comp_bacc.htm Aiken, L. H. PhD, RN; Clarke, S. P. PhD, RN; Cheung, R. B. PhD, RN; Sloane, D. M. PhD; Silber, J. H. MD, PhD (September 24, 2003) Educational Levels of Hospital Nurses and Surgical Patient Mortality. Retrieved from:
http://jama.jamanetwork.Com /article.aspx ?articleid = 197345 Ridley, R. T., RN, MSN, CFNP (April, 2008) The Relationship Between Nurse Education Level and Patient Safety: An Integrative Review. Journal of Nursing Education. 47(4) p.149-156. Rosseter, R.J. (January, 21 2013) Fact Sheet: Creating a More Highly Qualified Nursing Workforce. Retrieved from; http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf Starr, S. PhD, RN Edwards, L. PhD, RN (January, 1 2010) Why Should I Get a BSN? Tar Heel Nurse 72(3) p. 10-12 Gurvis, J.P. & Grey, M.T. (1995). The anatomy of a competency. Journal of Nursing Staff Development, 11 (5), 247-252

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