Degree Level in Nursing Versus the Baccalaureate
Multiple pathways exist today for an individual deciding to seek a career in the nursing profession. It can be intimidating to an individual trying to decipher the various educational programs and the relationship of each program to the future nursing practice (Creasia, J. L. & Friberg, E. , 2011). Programs at all levels provide these multiple pathways that can lead an individual to one or more nursing credentials (Creasia, J. L. & Friberg, E. , 2011).
The historical overview of the various programs available can help in building a greater understanding of the factors that are influencing nursing education (Creasia, J. L. & Friberg, E. , 2011). The associate-degree and the baccalaureate-degree levels of nursing both provide contributions towards the contemporary health care system, advancement of the nursing profession, and promotion of a profession dedicated to lifelong learning. In 1965, the educational entry point into the professional practice of nursing was designated to be the baccalaureate degree by the American Nurses Association (ANA) (Creasia, J. L. & Friberg, E. 2011). Three educational pathways for the registered nurse (RN) still exist more than 45 years later. These educational pathways include the diploma programs, associate degree, and baccalaureate. For an individual trying to choose the best pathway to enter the nursing profession, it can be confusing with the existence of the various program types that still exist today. Associate-Degree Level of Nursing In 1952, the Associate Degree in Nursing was designed by Mildred Montag in to assist in the shortage of nurses caused by World War II. These programs were an alternative to the collegiate preparation of technical nurses (Creasia, J. L. amp; Friberg, E. , 2011). A pilot project funded by the W. K. Kellogg Foundation in 1958 successfully led to a large increase in the numbers of associate degree programs in the United States (Creasia, J. L. & Friberg, E. , 2011). Community colleges started offering the associate degree programs, along with four-year colleges and the universities. By 1973, approximately 600 associate degree programs existed in the United States (Creasia, J. L. & Friberg, E. , 2011). Nearly 1,000 state-approved associate-degree nursing programs now exist today according to the National League for Nursing Accrediting Commission (NLNAC) (Creasia, J.
L. & Friberg, E. , 2011). Out of these 1,000 programs, 652 of them are accredited (Creasia, J. L. & Friberg, E. , 2011). Designed to be two years in length, the associate degree programs provide academic credit and consist of a balance between general education and courses in clinical nursing (Creasia, J. L. & Friberg, E. , 2011). The purposes of the ADN programs are to prepare competent technical bedside nurses for care settings that included community hospitals and long-term health-care facilities (Creasia, J. L. & Friberg, E. , 2011).
The intent Montag had towards associate degrees was that the ADN nurse would work under the direction of a baccalaureate level registered professional (Creasia, J. L. & Friberg, E. , 2011). This caused some confusion about the roles and relationships among the levels of nursing. According to the Maricopa Community Colleges in Arizona, their Associate in Applied Science (AAS) Degree in Nursing programs educate the registered nurse (RN) as a generalist who provides health care to clients and family groups. Their competencies relate to the art and science of nursing (Maricopa Community Colleges, 2011).
Graduates from the Maricopa Community Colleges are able to utilizing therapeutic communication and caring to create an environment that achieves desired client outcomes, demonstrate verbal, behavior, and written communication skills that are effective with health team member, and can care to a diverse population because they are culturally competent (Maricopa Community Colleges, 2011). They gain competencies to be able to utilize research and recommend evidence-based nursing care to meet individualized needs across the care continuum (Maricopa Community Colleges, 2011).
An ADN RN can demonstrate coordination of nursing care for multiple clients in collaboration with health team members (Maricopa Community Colleges, 2011). They demonstrate legal and ethical behaviors in all nursing activities, along with behaviors that promote the image and integrity of the nursing profession (Maricopa Community Colleges, 2011). The ADN RN will competently apply the nursing process to provide safe client care and produce positive client outcomes through the use of teaching and learning activities (Maricopa Community Colleges, 2011).
Maricopa Community Colleges nursing programs allow the RN to be able to safely provide evidence-based clinically competent care within the current healthcare environment by applying clinical reasoning and scientific principles (Maricopa Community Colleges, 2011). Last, but not least, the ADN graduate can demonstrate accountability for quality improvement in the health care system and provide safe, effective client care by integrating technology (Maricopa Community Colleges, 2011).
Graduates of the AAS Degree in Nursing programs are provided with an educational foundation for delivery into the university setting (Maricopa Community Colleges, 2011). I am an ADN graduate from the Maricopa Community Colleges. Baccalaureate-Degree Level of Nursing The University of Michigan established the first baccalaureate of science in nursing program in the United States in 1909 (Creasia, J. L. & Friberg, E. , 2011). Baccalaureate programs consisted of five years of education until the mid-1950s (Creasia, J. L. & Friberg, E. 2011). Today, most baccalaureate programs are now four years in length (Creasia, J. L. & Friberg, E. , 2011). Compared to the ADN graduates who are educated as generalists delivering health care to clients and family groups and their competencies are related to the art and science of nursing, baccalaureate graduates are “prepared as generalists to practice nursing in beginning leadership positions in a variety of settings” (Creasia, J. L. & Friberg, E. , 2011). Several components are essential to prepare nurses for this complex role.
Quality and patient safety, liberal education, information management, evidence-based practice, communication/collaboration, health care policy and finance, professional values, and clinical prevention/population health are all essential components for all baccalaureate programs (Creasia, J. L. & Friberg, E. , 2011). According to Grand Canyon University College of Nursing’s philosophy, “the nursing programs prepare graduates to provide excellent, holistic care while encouraging a passion for achievement, a lifelong curiosity for knowledge, and pursuit of advanced professional degree” (GCU, 2011).
Transitioning to the Baccalaureate-Degree Level of Nursing The movement to increase the number of baccalaureate-prepared nurses in the workforce is accelerating due to the release of landmark reports from the Carnegie Foundation for the Advancement of Teaching (2009) and the Institute of Medicine (2011) (AACN, 2013). These reports have linked nursing education to enhanced patient outcomes. The need to advance education is also being recognized by registered nurses.
In order to transition nurses to the baccalaureate level of proficiency, competencies must include the several essential components as listed in the baccalaureate-degree level of nursing section (AACN, 2013). The AACN Essentials of Baccalaureate Education for Professional Nursing Practice guides the curriculum for Grand Canyon University’s College of Nursing (GCU, 2011). Three dimensions of nursing education and formation were examined in the Carnegie National Nursing Education Study (Carnegie Foundation for the Advancement of Teaching, 2009).
The study showed a major finding that due to the demands of nursing practice, today’s nurses are undereducated (Carnegie Foundation for the Advancement of Teaching, 2009). “To meet the demands of an evolving health care system and meet the changing needs of patients, nurses must achieve higher level of education,” states the expert committee charged with preparing the evidence-based recommendations contained in the landmark report on The Future of Nursing released by the Institute of Medicine (IOM) in October 2010 (AACN, 2013).
Education has strongly impacted a nurse’s ability to practice (AACN, 2013). AACN also believes that patients deserve the nursing workforce to be the highest educated possible and the nursing profession should strive to be able to give that to their patients. Research reinforces these beliefs. For example, Dr. Linda Aiken and her colleagues at the University of Pennsylvania showed a clear link between higher levels of nursing education and better patient outcomes in their study published in the Journal of the American Medical Association in 2003 (AACN, 2013).
It was an extensive study on surgical patients and how their survival rate advantage was substantial if treated at a hospital with higher percentage of nurses with degrees at a baccalaureate level or higher (AACN, 2013). The study showed that “a 10% increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5% (AACN, 2013). ” The IOM is recommending that by 2020, the workforce should contain 80% baccalaureate prepared RNs (AACN, 2013). The educational preparation of a BSN nurse versus a diploma or and ADN degree does improve patient care.
An example of a patient situation I have experienced that supports this statement is when I witnessed my preceptor who is a BSN nurse educate a family on their child’s condition and hospital care. Having the background of performing evidence-based research, the BSN RN understood the reasoning behind current practices and was able to educate the family on the patient’s plan of care. Being a recent ADN graduate nurse, I felt undereducated and knew that my preceptor was better educated to assist the family with this task.
I know my clinical skills, but I am continuing my education to be able to understand the reasons behind our nursing practices. BSN nurses also tend to take a step back and look at the whole picture of patient care before jumping into a situation. This is extremely important when it comes to being on a Rapid Response Team or a Trauma Team. In these situations, I have seen the difference in approach with ADN nurses versus the BSN nurses. I look forward to continuing my education to becoming a baccalaureate-degree nursing professional and providing an even higher level of care to my patients.
According to Conceptual Foundations: The Bridge to Professional Nursing Practice, “the demands placed on nursing in the emerging health care system are likely to require a greater proportion of RNs who are prepared beyond the associate degree or diploma level” no matter which type of pathway one takes in the field of nursing (Creasia, J. L. ; Friberg, E. , 2011). I look at the pathway I have chosen in the nursing field and I feel that “it’s not where you start, but where you finish that counts (Dr.
Tim Porter-O’Grady). ”
References
- American Association of College of Nursing (AACN). (2013). Creating a More Highly Qualified Nursing Workforce. Retrieved on February 15, 2013 from http://www. aacn. nche. edu/media-relations/fact-sheets/nursing-worforce
- American Association of College of Nursing (AACN). (2013). White Paper on Expectations for Practice Experiences in the RN to Baccalaureate Curriculum. Retrieved on February 15, 2013 from http://www. aacn. nche. edu
- Carnegie Foundation for the Advancement of Teaching. 2009). Book Highlights from Educating Nurses: A Call for Radical Transformation. Retrieved on February 15, 2013 from www. carnegiefoundation. org/elibrary/educating-nurses-highlights
- Creasia, J. L. ; Friberg, E. (2011). Conceptual Foundations: The Bridge to Professional Nursing (5th Ed. ). St. Louis, MO: Mosby, Inc. Grand Canyon University (GCU). (2011).
- Grand Canyon University College of Nursing Philosophy. Retrieved on February 15, 2013 from https://lc. gcu. edu/learningPlatform/user/users.html?oken=oxZQCy8VMjQpm14sIn3jTa0SXVNp6bLCdTzhVnvsNXrt%2bE4%2fDNAR1q2VJGlolDMG;operation=home;classId=707215#/learningPlatform/loudBooks/loudbooks. html? operation=landingPage;
- Institute of Medicine (IOM). (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved on February 15, 2013 from http://www. iom. edu/~/media/Files/Activity%20Files/Workforce/Nursing/Future%20of%20Nursing%20Education. pdf Maricopa Community Colleges. (2013). Nursing. Retrieved on February 15, 2013 from www. maricopa. edu/programs/index/show/id:3812
