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Naursing Practice

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Educational Preparation
Danielle Andruzzi
Grand Canyon University
Professional Dynamics
NRS-430V (NRS-430V-0191)
Jane Maughon
September 8, 2013

Educational Preparation
I would like to start my argument with the differences between ADN and BSN. These differences are as follows: curriculum, patient outcomes and the approach used to nursing care. Patient care scenario that shows the differences in the approach to decision-making based upon the educational preparation of a BSN versus an ADN will be presented.
Mildred Montag developed the associate degree program. The two-year program was designed to deal with the nursing shortage during war times. Montag’s vision was to have these ADN working along side the BSN, who provided guidance. Nursing is an educated based career, with a strong knowledge for the sciences, organization and critical thinking. “Associate degree programs focus on the clinical skills needed for basic nursing tasks, but the baccalaureate degree add the component of a liberal arts education that is based on humanities, arts, philosophical, and theoretical approaches”(Shipman, Roa, & Hooten, 2011, p. 309). The associate program is usually found at a junior college. There is an even mix between education and clinical nursing courses. ADN nurses sit for the NCLEX exam to obtain their license, the same as the BSN. The associate degree program became very attractive to students because it was cost effective and it took half the time to start working. According to Associate Degree Nursing, (2009) “by 1973 approximately 600 associate degree programs existed in the United States. Today NLNAC states that nearly 1000 state-approved associate degree nursing programs exist”(Creasia & Friberg, 2011, p. 26). According to U.S. Department of Labor-Bureau of Labor Statistics (2007), “associate degree-prepared nurses are vital members of the nursing workforce”(Starr, 2010, p. 130). Today still they are the most significant postsecondary education to supply the needed growth in the nursing field. Nurses with two-year degrees are more likely to work with the poor, hospice and the mentally ill patient than graduates from baccalaureate programs. According to Nagler (2006), “at initial hiring, associate degree graduates are noted by some to be better prepared clinically than BSN graduates. According to Loquist, 1999; Nagler, (2006) after six months or more practice, though, BSN nurses have been found to be more motivated, self-directed, and assertive”(Starr, 2010, p. 130). “The first baccalaureate nursing program was established in the United States at the University of Minnesota in 1909”(Creasia & Friberg, 2011, p. 25). The program originally was five years total, two years of education and then three years of nursing. “The main difference between the three years of nursing in the baccalaureate and the diploma programs was the inclusion of public health nursing” (Creasia & Friberg, 2011, p. 25). Today’s BSN program is a four-year degree that costs more then double the cost of an associate degree. The BSN program has greatly matured over the years. Students that graduate from this program are ready to sit for their NCLEX-RN exam and are able to start their career at an entry-level management position. According to the American Association of Colleges of Nursing 2008, “The components needed to complete a BSN are liberal education, quality and patient safety, evidence-based practice, information management, health care policy and finance, communication/collaboration, clinical prevention/population health, and professional values”(Creasia & Friberg, 2011, p. 25). This type of education improves a nurses reasoning ability”(Shipman, Roa, & Hooten, 2011, p. 309). “Research has shown that lower mortality rates, fewer medication errors, positive outcomes are linked to nurses prepared at the baccalaureate and graduate degree levels” ("American Association of Colleges of Nursing," 2012, para. 1). In addition, Aiken et al. (2003) study found a BSN nurse delivers more competent care than associate degree nurses, because BSN improves the nurse’s practice and, therefore, the patient’s outcomes”(Shipman et al., 2011, p. 309).

A patient care situation that an ADN vs. a BSN may be different in decision-making is approaching the patient and the family with planning end of life care.
Patient is 80 years old with metastatic cancer; patient is in severe pain, short of breath and in and out of consciousness. The approach of the associate nurse to the patient and family is very direct and does not take in consideration the emotional stress of the family or their ability to process information. For example, the ADN nurse may address the family with the end of life question by asking them, “Do you want everything done?” The ADN nurse may us medical terminology to explain the do not resuscitate choices. She may become impatient with the family because she finds herself having to repeat the information. The ADN nurse is unaware of the patient’s family needs as well.
On the other hand the BSN nurse is aware of the family’s emotional stress and their inability to understand complicated explanations. She would interrupt the medical terminology into laymen terms. For example, when explaining the possibility of the patient being put on a ventilator, she would tell the family sometimes ventilators are called life support. She also realizes that she must repeat the information several times so the family is able to process the information. She is aware of the family’s needs and may offer the family a grief counselor.
In Summary, when I decided to return to school, I felt I was already a quality nurse. I wasn’t sure how three letters behind my name was going to change my practice. But after just two weeks I am convinced there is a need for the added education that is obtained with a BSN. The approach to patient care is going to be holistic. When an associate nurse comes out of school they are not equip with the knowledge to treat the patient with all the components of health. A state of complete physical, mental and social well being. Their education allows them to function in a task-oriented manner. Meanwhile the BSN has the education and therefore the knowledge to give complete holistic care.
After doing this assignment I have a greater appreciation for going back to school for my BSN, I truly understand why I am here.

References
Creasia, J. L., & Friberg, E. E. (2011). Conceptual Foundations: the bridge to professional nursing practice (5th ed.). St. Louis, Missouri: Elsevier Mosby.
Creating a More Highly Qualified Nursing Workforce. (2012). Retrieved from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf
Shipman, D., Roa, M., & Hooten, J. (2011). Healthcare organizations benefits by promoting BSN education. Nurse Education Today, 309-310.
Starr, S. S. (2010). Associate degree nursing: entry into practice-link to the future. Teaching and learning in nursing, 129-134. http://dx.doi.org/10.1016/j.teln.2009.03.002

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