Running head: BSN IN10 LEGISLATION
BSN in10 Legislation
Beverly Tennant
New York City College of Technology
Professional Nursing
NUR 4130 (84527), Sec E748
Professor Jose Hernandez
September 15, 2013
BSN in10 Legislation
The history of nursing is rich, filled with struggles, missed opportunities, visions, courage, and victories. According to Florence Nightingale Nursing is an art, it requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or cold marble, compared with having to do with the living body—the temple of God’s spirit? It is one of the Fine Arts; I had almost said, the finest of the fine arts. (Chitty, 1997, p. 26). Nursing education has undergone several changes to keep pace with the changing healthcare system and prepare leaders who are highly educated and technically sharp critical thinkers. The proposals under consideration require nurses prepared in diploma and associate degree programs to obtain a baccalaureate degree in nursing within 10 years of initial licensure. The current legislation is viewed by some organizations as a revisit of the old argument for the BSN required for RN licensure.
At present we have three educational pathways that anyone may follow to become a registered nurse. The first is a three year diploma program, nurses interested in technical practice would earn associate degrees in 2 years, and those interested in professional nursing would enroll in 4-year programs in a college or university. At the completion of school whether from a diploma, ADN, or BSN program all candidates must pass the national licensure exam. This enables the graduate nurse to practice as a registered nurse. At present the greatest number of nurses graduate from associate-degree programs (59%), followed by baccalaureate programs (37%), and then diploma programs (4%). Currently 42.2 % of registered nurses enter the work force with an associate degree. Some critics of BSN requirements for entry into practice argue there is no need to raise entry levels because passing rates for the NCLEX shows no differences among ADN, diploma and BSN graduates. (Huston, 2011). They can apply for the same enry-level positions at doctors offices, hospitals, and other healthcare facilities. In general both ADN and BSN graduates will earn the same amount for an entry-level job as a registered nurse. Additionally, many employers state they are unable to differenciate roles for nurses based on education because both ADN and BSN-prepared nurses hold the same licesure. Many critics of the BSN requirements for entry into nursing suggest that greater diversity maybe lost if entry levels are raised.
It is known that ADN graduates represent greater diversity in race, gender, age and educational experiences than BSN prepared nurses, who are younger and predominanyly white. According to Ms. Huston, annual school report of the California Board of Registered Nursing (2007) suggested that ADN programs have the highest percentage of ethic miniorities among students enrolling in prelicensure programs for the first time. In addition, the report suggested that ADN programs has the greatest percentage of ethic miniorities who completed a nursing program. Hospital and health care providers need nurses who can establish strong patient-client relationships with the growing miniority populations. These communities often have high proportion of immigrants and first generation members who have limited English skills. Nurses from similar backgrounds can gain the trust of these inidividuals; other nurses may not be aware of cultural beliefs and practices that can influence treatment. A diverse nurse workforce is a crucial component of effective community outreach efforts and to make our health care stronger. Therefore, getting rid of ADN programs could greatly affect minority students who usually use this program as a stepping stone to gain an education and change their economic status. Over the past few years several policymakers, researchers, practice leaders have identified that education does make a difference in how nurses practice.
In may, 2013, the Tri-Council for Nursing (AAACN, ANA, AONE, NLN) issued a consensus statement calling for all RNs to advance their education in the interest of enhancing quality and safety across healthcare settings. Those who support the new legislation claimed a BSN degree provides students with a more in-depth study of the physical and social sciences, nursing research, leadership and management, community, and public health nursing. This broader indepth education enhances the student’s professional development and reasoning ability. According to the American Association of Colleges of Nursing, education has a significant impact on the knowledge and competencies of the nurse clinicial. Nurses prepared at the BSN level are well trained in critical thinking, leadership, case management and health promotion, and are prepared to work in all healthcare settings. The report sited a study that was issued in the Journal of Nursing Administration by Dr. Linda Aiken and her colleagues showing strong link between RN education level and patient out come (Rosseter, 2012).
In one study, Impact of Hospital Nursing Care on Thirty day Mortality for Acute Medical Patient, which was cited by the article states that BSN prepared nurses have positive impact on lowering mortality rates . The study also claimed that 10% increase in the proportion of nurses with higher degrees was associated with 5% decrease in both the likelihood of surgical patients dying within thirty days of admission. The result from these studies concluded that healthcare organizations that have proportionally more BSN prepared nurses are at an advanatage when it comes to quality patient care. Nurses prepared at the BSN level are perceived to have better critical thinking skills, be less task-orientd, exhibit more professional behavior, have stronger leadership skills, and have a greater focus on continuity of care and outcome, and patient teaching. (Sharon S. Starr PhD, 2010, p. 130). Nurses were reportedly more satisfied with their jobs (Rosseter, 2012). According to internet sources studies found that nurses prepared at the baccalaureate level have stronger communication and problem solving skills (Johnson, 1988) and higher profiency in their ability to make nursing diagnosis and evaluate nursing interventions (Ginger & Davidhizar, 1990).
Ms. Zimmmerman an NYSNA member says it best, “I have always believed that nurses who work at the bedside should be the most educated, not the least educated, especially given greater patient acuity and the complexity of care.” She also mentioned that having greater knowledge gives nurses more confidence. Report by Delaney and Piscopo (2007) found that ADN nurses who returned to school for BSN degree reported improved critical thinking skills and enhanced professionalism. Students also reported that they saw a direct relationship between their education and their approach to patient care. Some Registered Nurses reported transformative experiences when returning for their baccalaureate degree in nursing, which included, changes in their prespective about nursing practice, changes in their thinking and reasoning ability, and becoming better decision makers. Increased knowledge help them to become better communicators, more effective agents of change, and advocate for their patient. Some also claim increase in assessment and clinical skills as well.
Rapid changes in health care mandates that the professional nurses possess educational preparation that will adequately prepare for the diverse responsibilities required of them today. As heath care shift from hospital-centered care to more primary and preventative care throughout the community, the health system requires registered nurses who are able to practice independently across mutilple settings. Top hospitals are already requiring BSN for newly hired RN, especially nurse managers, case manangers and in specialty areas such as critical care and public health. Today, most registered nurses work with interdisciplinary team with colleagues educated at the masters degree or higher level. Since nurses are primarily responsible for direct patient care and care coordination, they should not be the least educated member of the healthcare team. The BSN in 10 legistation is a very positive approach to raise the level of nursing education and give nurses time to complete their studies.Nurses are the largest group of licensed healthcare professionals, we play a major role in the design, delivery, and tranformation of healthcare Some will say encouraging the advancement of education through legislation such as this is will in the long run be for the greater good of the nursing profession. I cannot say persuing higher education has not enlighten me in many ways, change the way I view things and it has certainly enhanced my ability to give quality care to my patients. This debate will probably continue for years to come. However, it is becoming harder and harder for nurses with ADN degress to get jobs. Employers further validate the skills that baccalaureate prepared nurses bring to the workforce by paying through higher compensation levels. It is in the best interest of every nurse to persue higher level of education to stay competitive in the work force.
Bibliography
Chitty, K. K. (1997). Professional Nursing Concepts and Challenges. Philadelphia, PA: W.B Saunders Company.
Deborah T. Zimmerman, D. C. (2010). Advancing the Education of Nurses. The Journal of Nursing Administration, 529-533.
Debra Shipman, M. R. (2011). Health organizations benefit by promoting BSN Education. Elsevier, 309-310.
Huston, C. J. (2011). Professional Issues in Nursing Challenges and opportunities (3rd Edition ed.). Philadelphia, PA: Lippincott Williams & Wilkens.
May Way, M. M. (2007). Baccalaureate Entry to Practice: A Systems View. The Journal of Continuing Education in Nursing, 38.
Rosseter, R. J. (2012). Impact of Education on Nursing Practice. Washington DC: American Association odf colleges of Nursing.
Sharon S. Starr PhD, R. (2010). Associate degree nursing:entry into practice-link to the future. Teaching and Learning in Nursing, 129-134.
