There are three educational pathways one may follow to become a registered nurse. The first is a three-year diploma program; another is an associate degree, most often offered by a community college; the last is a four-year baccalaureate degree offered at four-year colleges and universities. Methodist College of Nursing (MCON) is an example of a baccalaureate degree program. The baccalaureate degree earned is the Bachelor of Science in Nursing (BSN). Presently, the greatest number of nurses graduate from associate-degree programs (59%), followed by baccalaureate programs (37%), and then diploma programs (4%). Graduates of all three programs sit for the same NCLEX-RN licensing examination.
These various entry levels into nursing practice have been the topic of discussion within the nursing profession for many years. In 1965, after a three-year study, the American Nurses Association (ANA) issued “A Position Paper on Education Preparation for Nurse Practitioners and Assistants to Nurses.” The paper stated, in part, that “the education of all those who are licensed to practice nursing should take place in institutions of higher education” and “minimum preparation for beginning professional nursing practice at the present time should be baccalaureate degree education in nursing.” While many groups within and related to nursing support this position, the three educational pathways to registered nursing still exist.
Education Makes a Difference
Over the past several years, policymakers, researchers and practice leaders have identified that education does make a difference in how nurses practice. The baccalaureate nursing program includes all of the content in the diploma and associate-degree programs, plus it provides students with a more in-depth study of the physical and social sciences, nursing research, nursing leadership and management, community and public health nursing, and the humanities. This broader and more in-depth education enhances the student’s professional development and allows the baccalaureate graduate to better understand the many social, cultural, economic and political issues that impact patients and influence healthcare.
Several studies have demonstrated an inverse relationship between the proportion of BSN nurses and mortality of the hospitalized patient. In other words, they found that as the proportion of baccalaureate-degree registered nurses increased in hospitals, patient deaths decreased. These studies demonstrate that lower levels of patient mortality are associated with the nurses’ education levels.
Nursing education is also associated with patient safety and quality of care. In Claire Fagin’s “When Care Becomes a Burden: Diminishing Access to Adequate Nursing,” it was recommended that, in response to the greater acuity of hospital patients, the numbers of nursing schools in community colleges and hospitals be decreased while the capacity in baccalaureate degree and graduate programs be increased.
Many groups such as the federal government, the military, nurse executives, healthcare foundations, nursing organizations and various practice settings advocate for an increase in number of BSN nurses in all clinical settings. The U.S. Army, Navy and Air Force require the baccalaureate degree for active duty as a registered nurse, and the U.S. Public Health Service requires the baccalaureate degree in nursing for a nurse to be a commissioned officer. A nationwide Harris poll conducted in 1999 found that 76 percent of the public believe nurses should have four or more years of post-high-school education to practice. Many countries, like Canada, Sweden, Portugal, Brazil, Iceland, Korea, Greece and the Philippines already require a four-year undergraduate degree to practice nursing.
Economy and Expediency Should Not Influence Education
It is clear that education influences nursing care. The argument is often made that the associate degree costs less and takes less time to complete. However, economy and expediency should not influence nursing education, and ultimately, patient care outcomes. It is more costly and there is more time involved if one first receives the associate degree in nursing and then goes on for the baccalaureate degree. The associate degree takes two to three years and the baccalaureate degree two to three years beyond that. Therefore, the individual will take four to six years for a Bachelor of Science in Nursing degree. In addition, many associate-degree graduates find it difficult to return to school due to work and life constraints, as well as simply being “out too long.” Research supports the importance of baccalaureate education for the registered nurse in relation to positive patient outcomes. The state nursing associations for New York and New Jersey have introduced “BSN-in-10” proposals to require the baccalaureate degree for all registered nurses within 10 years of graduation from an entry level RN program.
While many argue that the associate-degree nursing education produces more registered nurses for our communities in a shorter time period, this should not be the primary focus, nor should cost of education. The baccalaureate-educated nurse brings a more comprehensive and in-depth education to the healthcare arena than the associate-degree or diploma nurse.
Research has begun to show the importance of the baccalaureate education in relation to patient outcomes; however, nurses still remain the least educated of all health professionals. Yet it is the nurse who provides almost all direct patient care in hospitals and many other healthcare settings. We require the teachers who educate our children to have a minimum of a baccalaureate degree. Why then would we settle for less education for the nurses who provide the care to our loved ones during the most vulnerable times of their lives? iBi