Entry into Practice

Introduction: This assignment explores and answers thematic questions concerning education level for entry into practice, with an associate degree in nursing (ADN), Bachelor of Science in nursing (BSN), or a higher-level degree.

Question 1- According to Orsolini-Hain (2014) multiple compelling forces exist for increase entry into practice to bachelor’s or higher level.1Organizational demand and the ever evolving roles of nurses as well as the impact on the profession is cited by Orsolini-Hain (2014) a primary reason for many nurses seeking to further their education. 2 Much has been realized through studies regarding noted 2diminished mortality rates in acute care settings as well as overall best care practices where there are RN’s with a bachelor’s degree or higher.3 Nurses are also attaining higher levels of education due to readiness, as a result of right time in life. 4 Realization concerning desire in achieving personal goals of obtaining a bachelor’s degree as well as 5 the prestige of holding a higher degree, inspiration/support from colleagues and observing co-workers who have returned to college are also some of the greatest compelling forces that serve to increase bachelor’s and higher education attainment within the nursing profession (Huston, 2014).

Question 2-  The terms professional and technical are unnecessarily provocative in the debate entry -into –practice because there exist difference between the two terms pertaining to years of education received as well as the degree attained. A baccalaureate education is the lowest level of education in professional nursing practice and whereas the least preparation for beginning technical practice is an associate education. Technical nursing practices serves as the foundation for constructing a baccalaureate degree acting as a gateway for many (Huston, 2014). Though sharing many of the same courses, the professional degree is an extension of the technical degree and advances professional development. The term professional expresses a solid base in liberal education, management of multifaceted patient care, leadership skills, and the ability to manage in an efficient, cost effective way that provides safe care for patients (Huston, 2014).  Likewise, effective communication with many disciplines that are involved in delivering quality care to patients, knowledge of cultural competencies, management in public and community health, an understanding of health issues at a global and environmental level, nursing research/interpretation of up-to-date evidence into practice, information and management of technology used to provide quality care are all attributes that serve to make the debate regarding professional and technical an unnecessary one because differences can be noted between the two (Rosseter, 2014 & Huston, 2014). Additionally in looking at the development of the ADN its’ conception/intent by Dr. Montag’s was to support or assist the baccalaureate degree nurse not to serve as a replacement (Adelphi, 2010).

Question 3- The terms professional and technical are hot topics eliciting personal reaction because nursing educational requirements are evolving to fit the needs of ever advancing profession. A baccalaureate with its four-year educational requirement is viewed as a professional degree whereas a technical degree or ADN allow for practice at an associate (two year) educational level (AACN, 2005). The distinction between an RN with an ADN identifier and an RN with a BSN identifier is no longer one that goes unnoticed in health care to day. With healthcare organizations attempts at achieving magnet status where one of the noted recommended criteria by the Institute of Medicine’s (IOM’s) Future of Nursing Initiative is an 80% BSN equipped nurses by 2020 within organizations identified with magnet status (UC Davis, 2014). The push for higher education within the profession of nursing has become a contentious issue for those who feel that they do not need to attend institutions of higher learning in order to advance in the profession arguing that most needed knowledge regarding best practice can be gained through experience. Also as many organizations push to hire BSN’s this cause limitations on the ADN’s workforce options. Some view the distinction between the professional nurse and the technical nurse as an unfair one, after all they argue licensing (test) requirements remains the same for both the technical and professional nurse (Trossman, 2008). Though previously the distinction between the BSN and ADN was not a prominent one with many employers treating both the same, studies such as Aiken (Trossman, 2008) has shed light on the importance of academic advancement within the profession and has garnered  support from many of the movers and shakers associated with the profession. The associates include but are not limited to Robert Wood Johnson Foundation (RWJF), Association of Community Colleges Trustees, the American Association of Colleges of Nursing, the American Association of Community Colleges, National League for Nursing, and the National Organization for Associate Degree Nursing, the American Association of Critical Care Nurses, the National League for Nurses and the American Association for Nurse Executive (Rosster, 2008).

Question 4- As previously mentioned significant distinctions exist between an ADN and BSN. Four year conventional degree programs allow individuals to become well-rounded professionals within their field. In the case of an ADN a vocational degree is defined as being either career or skill exact and offers individuals benefits at a reduced cost regarding expense and time thereby allowing earlier access in attainment of licensure and entry into the workforce (Business Dictionary, 2014). In contrast students attending BSN programs will not have the early options available to them unless they choose the route of ADN/RN to BSN during which time they will still have to complete the equivalent of an additional two years of higher learning. Due the outlined distinction it is not unfair to label the ADN and identify it differently from the BSN. In looking at the development of the ADN its’ conception/intent by Dr. Montag’s was to support or assist the baccalaureate degree nurse not replace or serve as a replacement (Adelphi, 2010).

Question 5- The legality for requiring 60 to 1000 college credits at in an associate nursing degree program at the community college level is, to provide evidence that ADN are well educated, prepared, and competent to practice as nurses based on the curriculum provided at the community level. Moreover, many required college courses such as leadership, management, home and community health, indicate that students education is diverse at the community college level and associate degree prepared nurses are equipped to function in many roles to provide proficient care for patients ( Huston, 2014)

Question 6- Community colleges cannot award bachelor’s degrees because they lack the accreditation to do so. Community colleges do not meet the standards of the regional accreditation boards; they focus on technical practice and do not include the nine essentials competencies of the baccalaureate degree requirements. In order to award bachelor’s degrees community colleges would have to be reviewed and approved by the regional accreditation boards. Community colleges must have the same education foundation that is required in programs offered at four-year colleges to award bachelor’s degrees (AACN, 2005).  According to the AACN (2005) community colleges seeking to award baccalaureate degrees should look at partnering with four-year institution in developing comprehensive programs. It is important to note that there are also state regulations and laws that vary regarding community colleges ability concerning awarding bachelor’s degree.

Question 7- According to Aiken, Clarke, Cheung, Sloan and Silber (2003) in studying the relationship between educational levels of nurses and patient outcomes a positive correlation could be noted between the two. Aiken et al, (2003) used, descriptive research design in the form of cross sectional analysis in order to study educational level effect on patient outcomes. In examination of 80% of hospitals in Pennsylvania using discharge abstracts as well as survey data from randomly sampled nurses and the treatment facility characteristics, it was found that as the amount of nurses with bachelor’s degree in an organization increased surgical patients mortality within a 30-day window decreased.  Specifically a 10% rise in the amount of nurses with a BSN’s was related to a 5% reduction in patient expiring post surgery (Aiken et al, 2008). It is also noted that the researchers suggests that lighter workload in conjunction with a BSN would also result in much improved patient outcomes. The implications of the Aiken et al (2008) study is/was significant because it suggested that health care facilities would benefit from higher education nurses.

Question 8- Nursing roles and responsibilities are undeniably critically complex because lives depend on the care provided by nurses. Social Workers role in the provision of healthcare service is a notably complex also regarding medical and mental health. Unlike nurses social workers do not administer medications, however they can document on patient’s conduct, discharge planning, care coordination, psychosocial assessment, and case management. Social workers education requires a MSW (Masters) and licensure in their field in order to serve as Medical social workers (Pedde, 2012) even though to some extent their jobs are not as complex as nurses. Similar to social worker Dieticians are also involved in patient care their minimum degree requirement is a bachelor’s degree. Individuals working in health care settings generally have a minimum of a Master’s education, as well, as their professional nursing license. They work as members of interdisciplinary teams and provide patient nutrition consultation, counseling (CAD, diabetes. etc.). It is important to note though nurses provide complex direct hands on, invasive care such as; transfusions, assisting providers with procedures, dispensing critical medications and the ability of anticipating what must be done in the event that patients’ health become compromised. The two health professions mentioned duties are not difficult as nurses conversely their degree requirement is significantly higher than that of nurses (Pedde, 2012) Other responsibilities performed by nurses are teacher, advocate, agent of change, leader, manager, researcher and much more (Zerwekh, J. & Claborn, J. 2009).

Question 9- The likelihood of nurses and their representing organization coming to a general consensus regarding entry-into practice is good. Nurses have always been adaptable from the beginning of the profession’s inception. NLN (2012) points to proposed options such as BSN in 10 already being considered in order to address the need for educational progression within the profession in order to address gaps in specialties and other area. Most importantly due to the implication pertaining to patient outcome being significantly improved as a result of an increase concerning BSN in practice as well as propose Magnet statuses of organization (UC Davis, 2014) the profession will have no choice but to come to a general consensus regarding entry into practice or run the risk of throwing the profession into considerable turmoil.

10 & 11– If the entry level is raised to BSN grandfathering should be used for those not meeting the entry-level standard but it should be used in a strict conditional manner. Revision of training completed in professional practice should be taken in context along with experience and career advancement during that time regarding what role and level the individual is currently performing at. There can also be different levels concerning grandfathering (i.e. an individual maybe identified as level P and be required to complete X amount of hours of training in area S prior to being grandfathered). Those not covered by grandfathering can be covered by BSN in ten years (Huston, 2014) with the support of organization.

Question 12- Is the goal of BSN entry by 2015 a realistic goal? The goal of BSN entry by the year 2015 is a realistic one because the debate and identified need for more educated nurses is not a new one in the profession. All parties have not officially agreed, however nurses who are graduating with an associate’s degree and those who are practicing with an associate’s degree are pursuing a BSN degree in order to be prepared with a higher level of education while the debate continues. This goal can be achieved but it may become a reality beyond 2015.

Question 13- Bill number A03103 proposes that nurses with current ADN must complete their bachelors within 10 years from the date of their licensures in order to maintain licensures for practice. Additionally discretional /conditional terms are set forth for those who do not meet the requirement allowing an additional year. The purpose the bill also note is to continue to allow for differing entry points into the professional while allowing for attainment of the set minimum professional standard.

 

 

 

 

Reference

AACN. (2005). Position statement on baccalaureate nursing programs offered by community colleges.

Adelphi University. (2010). Do no harm. Retrieved from  http://www.csun.edu/~meh20426/426/11DoNoHarm_NursingEducation.pdf

Aiken, L. H., Clarke, S.P.,  Cheung, R. B., Sloan, D.M and Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623.

Business Dictionary. (2014). Vocational Degree. http://www.businessdictionary.com/definition/vocational-degree.html#ixzz2v1B5rYiv

Huston, C. J. (2014). Professional issues in nursing, challenges and opportunities.                 Philadelphia, PA. Lippincott Williams & Wilkins

Orsolini-Hain, L. (2014). What’s all the Fuss? Working Towards a Baccalaureate or Graduate Degree in Nursing. Retrieved from http://www.nsna.org/careercenter/fuss.aspx

New York Assembly. Bill 3103 an act to amend the education law, in relation to the educational preparation for practice of professional nursing. January 2014.

NLN. (2007). Academic/professional progression in nursing.  Retrieved from http://www.nln.org/aboutnln/reflection_dialogue/refl_dial_2.htm#top

Pedde, J. (2012). The five most popular social work jobs. Retrieved from http://msw.usc.edu/mswusc-blog/the-five-most-popular-social-work-careers/

Rosseter, R.J. (2014). Fact sheet: the impact of education on nursing practice. Retrieved from http://www.aacn.nche.edu/media-relations/EdImpact.pdf

Trossman, S. (2008). BSN in ten. American Nursing Today, 3(11).

UC Davis. (2014). Nursing. Retrieved from https://www.ucdmc.ucdavis.edu/nurse/magnet/faq.htm

Zerwekh, J. & Claborn, J. (2009). Nursing Today: Transitions and Trends (5^th ed.). St.

Louis, MO: Elsevier, Table