Education of the Modern Day Nurse
Minimum education requirements for the registered nurse (RN) have been in question for many years and are still the subject for research and debate. The most common programs are the associate degree, diploma, and bachelor’s degree programs. Associate degree nurses (ADN) and diploma nurses make up the majority of nurses graduating today due to the timely and cost effective manner of obtaining their RN in approximately three years. The ADN comes out of a program adequately prepared to practice nursing safely and competently at the entry level position but they do not encompass further education and knowledge that higher degree nurses acquire. Baccalaureate prepared nurses (BSN) are prepared with similar training as the ADN and diploma nurse but they have much more extensive education and training. The BSN possesses a broader, well rounded perspective of nursing history and theory which will help them to excel at their role as an RN. While the ADN and diploma programs produce nurses that are fully capable of practicing at a basic level of nursing, the competencies of the BSN are more widespread and extensive, and therefore produce a nurse better prepared to take on the changes and challenges in an evolving healthcare system.

Different Nursing Programs

Continuing education for nurses has been offered since the practice was introduced many years ago. As is/was the case now and back then, enrollment in undergraduate and postgraduate programs remained lower than the AD and diploma programs. Some reasons why individuals have not pursued higher education are due to the financial and time demands. The AD programs allow for a more diverse student nurse population; the cost and time frame make it very attainable for those of all socioeconomic backgrounds. The BSN offered at colleges and universities takes longer, four years, and is significantly more costly (Creasia & Friberg, 2011 ). Each nursing program has the common goal of graduating nurses prepared with the knowledge, skills, and values that enable them to provide quality care within our healthcare system.
For the nursing profession to progress forward with higher education requirements, there needs to be set standards for the expectations of the entry level RN. Incentives are also necessary to encourage nurses to continue their education such as affordable tuition costs, reimbursement, and compensation in the workplace. Motivation is essential in this profession to encourage nurses to remain an integral part of positive patient outcomes.
A Call for Reform

There have been studies done that emphasized the need for change in nursing education standards. The Institute of Medicine (IOM) called for reform in the educational standards for nurses in their 2010 report on the future of nurses, and in that report, recommend having 80% of nurses prepared on a baccalaureate level by the year 2020 (Institute of Medicine, 2010). The IOM is enlisting the help of magnet accredited hospitals to attain this 80% BSN or higher workforce. Magnet hospitals are touted for low RN turnover, excellent nursing care, and positive patient outcomes. As more hospitals strive for this prestigious recognition, the 80% BSN workforce seems attainable by the year 2020 due to an increasingly competitive healthcare environment (Magnet Recognition Program FAQ: Data and Expected outcomes, 2012). More nurses with higher degrees at the bedside will benefit patient care greatly, as nurses stive to provide the best possible patient outcome.
Difference in Competencies

Nursing students in ADN and BSN programs appear similar, though ADN students present to be more prepared clinically than their BSN counterparts. The difference in ADN and BSNs are more evident with regard to critical thinking and community health knowledge. The BSN excels here because their educational base starts with deeply ingrained theory and history of nursing, excellent elaboration on the nursing process and critical thinking, as well as a strong community health knowledge base (Creasia & Friberg, 2011). A firm foundation with emphasis on the theory and history of nursing is essential to better contribute to critical thinking skills and decision making. Community health is becoming an area of increasing importance as treatment moves out of the hospital and into areas such as ambulatory care centers and home health settings. The BSN is more adequately prepared to use critical thinking, evidence based practice, and leadership skills from having fuller, more detailed coursework (Creasia & Friberg, 2011 ). All these skills are found to significantly improve patient outcomes. Dr. Aiken’s study on the effects of nursing education on patient outcomes found that for a 10% increase in BSNs on staff there was a 4% decrease in the risk of death based on many factors (Aiken, 2003). This evidence has shown how essential it is to have at least a BSN in order to give the most competant patient care. For nursing to move ahead with the times nurses need to be on equal grounds with the other health professionals in the workforce. In today’s healthcare system the complexity of care is at a high and nurses are involved with other professionals to manage our patients. Social workers, physical and occupational therapists, all require at least a masters degree in many parts of our country. Nurses need to move up to at least the bacclaureate level in order to hold equal stance with our interdisciplinary health professionals. Then there the basis for equal partnership to create a highly educated and competant healthcare team.

Education and Care Decisions

An example of a patient situation in which a BSN would be at an advantage would be in the case of a terminally ill patient. Taking care of a patient who is at the end stages of life requires much training and preparation of the nurse. There is the whole picture to look at here, the patient and family, with a need for physical, emotional, and spiritual support at the forefront. The BSN is trained extensively in the treatment of the patient as a whole as well as in the stages of death and dying and the teaching that a situation, like a terminal patient and their family requires. The decision making that comes along with end of life is something that requires sharp critical thinking and leadership skills (Creasia & Friberg, 2011 ). The ADN may not be as well prepared as far as being able to teach and support the family while helping them to make decisions based on the best interest of the patient. The family will be looking for guidance and a BSN prepared nurse would most definitely be trained to make such a tough situation as comfortable as possible.
Conclusion

During this research, it has been revealed that there is a need for consistency in the educational requirements for entry level nursing. Regardless of a nurse’s initial educational level, they are still capable of being an effective nurse but they can better their skills and practice even more with higher education. Today’s nurses are overwhelmed by the time and financial demands to obtain higher education and for this to change; more options need to be made available for them. The need for change prevails as we move forward in our ever-evolving profession.

References

Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003, September 24). Educational levels of hospital nurses and surgical patient mortality, Journal of the American Medical Association, 290, 1617-1623.

Creasia, Joan L., and Elizabeth Friberg. Conceptual Foundations: the Bridge to Nursing Practice. 5th ed. St. Louis: Elsevier Mosby, 2011.

Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press.

Magent Recognition Program FAQ: Data and Expected Outcomes. (2012, November 8). Retrieved April 10, 2013, from http://www.nursecredentialing.org/DEO-FAQ.