Do Baccalaureate- Prepared Nurses have Higher Level of Clinical Competency and Care Delivery over Associate Degree Nurses?
Susan Olson
Grand Canyon University
Professional Dynamics
NRS-430
Dr. Monica Kidder
June 10, 2016
Do BSN nurses have higher level of clinical competency and care delivery over ADN nurses?
The American Association of Colleges of Nursing has compiled a fact sheet: “Creating a More Highly Qualified Nursing Workforce”(Rosseter, 2015, p.1). This fact sheet is a very extensive list of worldwide research connecting education to outcomes. This list is compiled of about twenty-four major research studies with very compelling evidence to support the overall claim that having more baccalaureate-prepared nurses(BSN) in the workforce will increase patient safety and decrease patient deaths. The numbers are consistent throughout all the research provided in the fact sheet. Basically, a 10% increase in the proportion of baccalaureate-prepared nurses decreases the mortality by roughly 10%. (Rosseter, 2015). Associate Degree Nurses (ADN) are equated with entry level nursing, and BSN nurses are considered more advanced because of the higher level of education. Education, being the key word here, not necessarily that BSN is better than ADN. After reading the research, an ADN could come away feeling like they are in some way, not as good as the preferred BSN graduates.
The American Organization of Nurse Executives state this push for higher education is preparing a workforce that is improving patient safety and providing better nursing care. Therefore, they are more adequately prepared for their challenging and complex roles. Education of any kind whether it be formal college education, continuing education credits, or becoming certified leads to better practice. Knowledge is not a final destination that can be obtained completely, not until death. But education without dedication is empty. There are growing bodies of evidence that support education and shows the impact on a nurse’s ability to practice. But what about her desire to practice? Does more formal education increase her desire to perform better or just give her more flexibility in the positions she can attain? Are there different competencies that a BSN possesses that an ADN doesn’t? According to the Committee of the American Society of Nursing Services Administration they saw no difference among beginning practitioners from BSN or ADN programs. “They stated that licensure was the same for each and the legal responsibility was identical” (Schank, & Stollenwerk, 1988, p. 254). They also agree that formulating staffing patterns and job descriptions that were different for the BSN and ADN is not practical or cost effective. Most would agree that BSN graduates are adequately prepared for leadership/management roles. It’s interesting to find that ADN graduates are also accepted into this role when looking at their experience timeline. Both levels of graduates, when being considered by nurse executives for leadership roles have the same length of experience requirements. Charge nurse requires one to two years. Head nurse requires three to five years. Supervisor requires three to six years. (Schank, & Stollenwerk, June 1988). According to Creasia & Friberg (2010), “The scope of practice for the BSN and the ADN is undifferentiated because both groups are issued the same license. This limits differentiated roles in the work place and hinders the reward system for leadership responsibilities” (p. 37).
Personally, when working alongside BSN nurse’s there have been many co-workers that have no regard for the patients’ needs, wants or desires. These employees are only concerned with completing tasks and then working on their social life. It is more important to discuss the latest thing on Facebook, than it is to give pain medication on time, or turn and reposition a patient before going to lunch. Several BSN co-workers come to mind from different hospitals that fit this description. So, is it the formal education that better prepares clinicians for their challenging and complex roles? Could it be a deep rooted love for the profession that compels the nurse to seek out education for herself and for the patients she serves. Education when added to a dedicated soul makes a better prepared nurse, not just because she attended a BSN program.
The one of many patient situations that I can reflect on that continues to emphasize with my feelings as described above. I had just finished report and had been informed that this wonderful elderly woman had an episode during the night of respiratory distress and needed go back on the Bilevel Positive Air Pressure machine (BiPAP). She had improved after the application of the BiPAP and was resting comfortably. Shortly after entering her room she became worse and was in distress again and the mask was still on. Respiratory department was called and they adjusted her settings and she stabilized again. Trying to hear a patient speaking with one of these masks on is very difficult, but she clearly told me, I’m done. I ask her to repeat herself, in case I misunderstood her. She said the same thing and this time she went into more detail so that I could understand. She wanted the mask off and be allowed to die. Her exact words were, “I want to die today.” She started to give me a list of things she wanted to be divided among her children. After calling the doctor, I made that call to her family, asking them to come into the hospital. When her children were around her bed all holding hands in one big circle, she smiles at me and says, “Take off the mask”. After falling asleep from the morphine, I took off the mask. She was gone by 5pm. All the time, dedication, education and love spent in that room that day, by me had nothing to do with whether I had a BSN or ADN. It was about the absolute wonderful gift God gave me.

References
Creasia, J. L., & Friberg, E. (2010). Conceptual foundations:The bridge to professional nursing practice (5th ed.). Retrieved from https://evolve.elsevier.com/cs/product/9780323068703?role=student
Rosseter, R. J. (2015). Fact Sheet: Creating a More Highly Qualified Nursing Workforce. Retrieved from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf
Schank, M. J., & Stollenwerk, R. (1988, June 6, ). The leadership/management role: A differentiating factor for ADN/BSN Programs? Journal of Nursing Education, 27, 253-257. Retrieved from http://www.healio.com/nursing/journals/jne