The Importance of the Baccalaureate Degree in Nursing Education

by Kimberly A. Johnston Ed D, RNC, CNE
Methodist College of Nursing

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


How can you possibly say that current issues in nursing are not applicable to the skills of a nurse when nursing practice itself is based on current evidcened based practice? And when you focus on the "critical thinking" skills of a nurse, if you only have the technical training provided by the ADN programs, you do not have a broad understanding of the why's and how's, you only have the technical requirements needed to perform the functions, which is all well and good if you are the type of nurse that only wants the minimum required knowledge base required to do the job. I hate to tell you, nursing is more than just putting in an IV or performing a standardized assessment. You actually do apply theory and sociology if you know what it is and how to use it.

As far as the nurse making the nurse, how misinformed you actually are. My FNP-BC, PNP-BC and DNP degrees have absolutely molded my mind and enhanced my practice into what it is. I surely didnt do it by myself without the education....

I am a BSN nurse from Malaysia. My country does train diploma nurses and degree nurses. I was one of the furtunate one who obtained local university offered course of Bachelor in Health Sciences (Major in Nursing). Before i was recruited, i personally went to work as a nurse assistant in a private hospital (3 months)  just to get some experience, overview of the roles and routines of a nurse.

In order to get into BSN,  i am  required to complete 2 years of pre-university course (STPM) right after 11 years of basic primary and secondary school program. I was indeed uneasy to pass all subjects. As a degree nursing (4 years course) student, we have practical started only from second year of nursing as we have a thoroughly anatomy & physiology, biochemistry, courses with all the other students of dietic, biomedic, medical radiation, nutiritionist, and sport science students.  My nursing journey started on year 2 to year 4.  Year 4 are mainly practical in all different department and at night we do our nursing research. At the end of our nursing course, we were trained they same in skill as diploma student but we have deeper knowledge requirement and  research skills plus others business/ forensic/sport science skill as to be more diversity equiped nurse.  My classmates and i did face challenges and critics from diploma nurses as they are they one who guided us during practical posting in all ways.  We always make them fuss and treated as we degree nurses always ask " WHy" in every skills and procedures. Doctors finds favors on us because we are more curious to learn and having more guts to question in order to learn.

After graduate, many senior diploma nurses finds us treatening and uneasy to teach as degree nurses are trained to think and analyse everything to the details. It is sometimes uneasy for diploma nurses to understand as they are well trained to respect and follow seniors in all procedures, policy, and culture. As we are called degree nurses, we have higher espectation from those diploma nurses. But diploma nurses just can not understand that degree nurses are trained they same in skills part as diploma nurses. Nurses always assess each other capabilities through skills. (it is unfair, we are trained the same. hence, we need time to catch up on hands on skill too.)

On the other hand, we have more skills and expert besides nursing EXP: COmmunication, computer skills, research skills, lab skills (Culture and swabs), exercise, health teaching, project management, setting up own business.. and etc) which doesnt use or being assessed in the clinical.This skills will be needed when we become a leader in future, and from starting point, we are all ready to excel!)

As per nursing community expectation required, i paid myself to pursue CCN (citical nursing care) right after 3 years of working experience in medical surgical wards, diagnostic room, cath-lab, and chest clinic. It was uneasy to go through with little exposure but i did it with maximun passion and enthusiasm. In malaysia, many diploma nurses waited at least 5 years to be sponsored  to persue post basic courses with contract.

During post basic course, i did better than majority of diploma nurses with ICU experiences (min 3 to 5 years) ( but low census in their Hospital). As i have went through BSN first year studies, all foundation of biochem,anatomy and physiology are easy to catch up and refreshing indeed, while my diploma classmates all struggling with the studies. Indeed, i find in difficult during practical and skills as i don't have much experienc in ICU and almost lost touch in nursing care after working in respiratory clinic. But i went through and excel very fast after being guided by passionate and experienced senior nurses.

I am now working partime as a CCN in icu of one private hospital (high census- full 12 beded). Able to take care 3 ptca patients; 1 ventilator +post ptca patients (or light cases). At the same time i am currently doing Master in Nursing Health Sciences (partime 3 years mixed mode).

My clinical instructors are BSN also with two post basic qualification and 15 years of experience in nursing. I find her very boastful but still i am willing to learn and listen to her advice even she always put me down in all colleagues by saying that i have Master. Comparing myself with those diploma nurses, the first time i work in ICU with zero experience but CCN , i can compare my skills with those who have worked 3 years without CCN. Deep down, I still believe, BSN nurses can excel and go further compare to diploma nurses.  Maybe those who are not taking nursing as a noble job but a job for salary will be different and soon to be looked down by diploma nurses. I strongly believe that as a nurse with altrusim, autonomy and a humble heart  will be a great nurse.  Back to the point:

1. It is experience that makes better nurses.

2. It is qualification that can empowered a well equiped experience nurse.

3. Qualification first or experience first? It is only a time matter. But qualification is indeed needed to serve the more knowledgeable society.


Submitted by Yeeleng on Sun, 03/13/2016 - 09:37


I'm struggling to understand the qualification process in the USA- I'm half way through a 3 year Bsc in adult nursing in the UK. My year is 50% theory (although clinical skills are taught in simulated wards regularly) and 50% on clinical placements lasting 4-6 weeks in a variety of settings e.g. acute medical/surgical, community. From day 1 there is huge focus on patient centred care and evidence based practice. There is controversy here about the benefits of university trained nurses compared with hospital trained nurses. I have found that there is some snobbery towards students being called too posh to wash but that is absolutely untrue in the majority of cases. I have learned so much from experienced staff without a degree and am in awe of their knowledge but....give us time and we will get there- nobody woke up and suddenly had expert skills! Mentorship and exposure will help to put theory into practice. I would agree that a nurse with a degree but no compassion or communication skills is useless and dangerous to the profession however a caring nurse with limited knowledge or ability to understand new technology, research and protocols is not someone who can provide good quality, holistic care. The healthcare needs and treatments are constantly evolving so maybe the scope of nursed today is not as romantic and altruistic as it is expected to be but as a student we are reminded of core nursing beliefs and values which underpin everything we do which I feel are enhanced by higher education.  

Submitted by Lola on Wed, 05/11/2016 - 17:47


The need to standardize the Nursing profession should not be a form of entertainment. I understand individual pride in their various achievements but we must collectively have pride in the nursing profession. When I started the BSN program some years back, I felt a course in understanding movie was redundant. Guess what!  I can direct a movie on healthcare in my little medical room without problem. I present health talk in the school through dramatization. My actors and actresses are my regulars to the medical room.   The baccalaureate program makes it possible for me to understand and address the social, political and cultural needs of my community.  Yes! Nursing involves practice, but how do you give quality health care without understanding the patient’s background?   Remember! The baccalaureate program will give a wider scope to a better quality of care.

Submitted by Juliet on Fri, 07/08/2016 - 11:41


I am a ADN-RN who was 45 when I applied to nursing school.  SoI had successfully brought with me my experiences in management trained by one of the top ten management systems in the world in th 1980's, customer service skills, learning the ability to listen and help in customer service the best way possible with the proper training and support available to me.  I chose to go to nursing school due to my extreme interest in medicine and my need at the time that i really wanted to help sick and ailing people, especially the elderly which have a soft spot in my heart. In my mind they of all people deserve only the best care available as they have supported the world the younger generation now lives in and deserve the best care of their lives as they age and their human condition deteriorates . I am humble but have been told that I am extremely intelligent, am extremely inquisitive and ask many questions for validation, clarification of the facts and to extend my own knowledge. This appears to intimidate people. At my age i did not think medical school was a good investment as the ability would be somewhat limited after my education and residency would put me in the senior age group lessening my chances to be gainfully employed. So after having career counseling and talking to peers I decided on the current plan of action.  So I attended Jefferson State Community College in Birmingham, AL and graduated Summa Cum Laude.  While intially working within a hospital setting in ortho surgical recovery and rehab and then later for two years in a Open Heart/Cardiac floor for over two years which I have enjoyed the most in my nursing career.  My family is in Ohio and my mother was ailing and had really no ties to the Birmingham area, I decided to move back to Ohio.  Went through all the required steps to get my RN license in Ohio, that's when things took a turn downward.  There is a plethera of BSN nurses in this rural area and it ended up the only position I could acquire is in long term care. While I thought this maybe a good fit as I cared for elderly and rehab patients, it soon became apparent it was basically about "filling the beds" as stated by administrators I worked with , I tried as best as I could to do what was asked of me but allowed myself to be pushed past my professional and personal tolerances,   it's slowly took its toll on me as i was assigned the care of 28 to 32 patients, one nurse with two aides but if one aide did not show up, it was expected that us that were there to pick up the slack.  My tolerance lasted about 2 years in three different nursing homes but each time i find myself in the same position.  I was tired of apologizing to residents about things that were out of my control. Superiors did not want to admit that guidelines by the Ohio state board of nursing were not being followed stating " Well, we don't do things around here like that"  Being past my personal and professional tolerances working in what appeared to be a "toxic environment", my ability to filter my verbal comments became less and less. I am now being investigated by the Ohio board of Nursing as if I am fit to provide safe bedside care to residents. Upon review with the Board of Nursing it was explained to me that his assessment was employee/employer related and did not relate to ultimate nursing practice. My ultimate and main concern was these elderly and disabled residents were not being given the care they so rightfully deserved.  I have been an RN for 10+ years and honestly feel there is a great chiasm between what is written in words and the physical and emotional care given each day by a truly gifted nurse.   A sheet of paper regardless of the credentials simply resides on a desk or in a file while a truly effective nurse is a physical experience that happens daily and cannot be truly captured in words and is the ultimate in the care they give to the patient.


James G. Hartke, RN    ..... and proud of it 

Submitted by James G Hartke on Sat, 06/24/2017 - 19:39


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