The world we live in is constantly changing. Experts tell us that information and technology is changing approximately every few days. People love to keep up with the latest technology and spend money they don't have to enjoy gadgets and services whose functionality and warranties will expire long before their credit card bill is paid off. Is there a similar trend reflected in nursing? Is getting a BSN the new gadget IOM is pushing for in an effort to justify a proposed change in nursing that is ultimately a business decission? Is the cost worth the end result? Does a baccalaureate degree prepared nurse perform better than an associated degree prepared nurse? Let's explore some of the available data from recent statistics and research studies.

According Altman (2012), having a BSN degree does not automatically or necessarily translate into better wages. Nurses with a BSN degree who choose to practice as bedside nurses may not see a financial reward. However, there are other benefits which can make the education increase in value. BSN nurses have a greater opportunity to advance in their career and apply their professional knowledge to enhance the quality of patient care. For those desiring to pursue even higher educational degrees, a BSN may be just the beginning toward highly satisfying financial rewards such as an APN. Nonetheless, improving patient outcomes based only on the degree of nursing education seems to be a highly debated topic (Altmann, 2012).

"Creating a More Highly Qualified Nursing Workforce" published by the American Association of Colleges of Nursing listed the results of several research studies which emphasized the idea of a strong connection between higher nurse's education and decreased patient mortality. However, the lower mortality rates mentioned ranged from five to only fourteen percent and were not actual statistical facts rather just predictions or odds (Rosseter, 2015). This leaves the reader to believe that there are more factors that influence the patient's outcome which must to be considered rather than only the degree of the nurse' education. Any practicing nurse knows that patient outcome statistics are very relative. When considering outcomes even if based on the exact treatment and length of hospital stay, a lot of other factors come into play. Some examples are patient's age, gender, comorbidities, compliance with diet, treatment, follow up appointments, and family support. Even if all these components were equally factored in into the research studies, there still remains a certain degree of inaccuracy of the results based on patients' genetics and his or her response to treatment at the time of the study. Let's suppose the nurses team consisted of higher numbers of BSN nurses compared to ADN nurses. The studies do not reveal the patient's condition or response to treatment in the days prior to the study. To assume that a better outcome was achieved just because more BSN nurses were taking care of the patient at the time of the study is only hypothetical. To present a fair comparison of actual results, studies must include the exact number of patients with the exact age, gender, compliance, comorbidities, course of treatment, family support, and the same BSN nurses, same physician treatment team including even the same attending and specialists for all patients in the study. Even if these ideal research study conditions could be achieved, there is still room for error in presenting results based on patient's genetics. It is a known fact that for whatever unknown reasons, certain patients respond better than others to the exact course of treatment. And this remains a variable that no research study is able to account for. Therefore, generalizing that patients treated by BSN nurses have a higher chance of better outcomes is not necessarily true.

Dana Weinberg along with the co-authors of "Analyzing the Relationship Between Nursing Education and Patient Outcomes" presents a more realistic view of the problem surrounding differences in competencies based on the degree of education of the nurse. Further factors were therefore explored. The researchers of this study did not find a direct relationship between the percentages of BSN prepared nurses and patients outcome. However, their results indicated that better patient outcomes can be achieved if there are better work environments for the nurses, regardless of their degree. They also found that nurses with more years of experience are better communicators, therefore easily facilitating the communication between all members of the healthcare team and ultimately benefiting the patients. This study suggests further information is needed since the quality of patient care does not necessarily reflect the value of the BSN education, but rather the significance of the work environment (Weinberg, Cooney-Miner, Perloff, 2012).

However, due to recent medical advances, today's hospitals need to be equipped with a more specialized clinical workforce. While associate degree prepared nurses have the necessary skills to master the clinical aspect of nursing, better preparation is needed to deal with the other aspects related to nursing. The BSN coursework prepares nurses to better evaluate research studies and apply them to everyday practice. If a change is proposed within the institution, the BSN prepared nurse can use her skills to evaluate the effectiveness of the new policy by researching the topic and providing answers to the less informed or to the ones questioning or resenting the change. The BSN nurse also has advanced theoretical knowledge in ethical, legal or social issues. Their perspective is also broadened by having taken courses such as Spirituality in Health Care (Grand Canyon University, 2015). Bachelor degree nurses are valued for their critical thinking skills, leadership and health promotion as well as their ability to extend their practice and influence in various inpatient and outpatient settings, from schools to surrounding communities (Rosseter, 2015).

A patient care situation where these differences in education between ADN and BSN nurse could surface would be an ethical decision. While the ADN prepared nurse might be more inclined to focus on the immediate patient care, the bachelor degree nurse will be able to look at the bigger picture and know which resources to summon if needed, before the situation got out of hand. And since every ethical decision involves some degree of spirituality, the BSN prepared nurse would be able to apply her knowledge on the topic and facilitate better communication between the patient and the family and present them with options based on the latest evidence- based practice research.

"The commitment to lifelong learning is a professional values and a hallmark of all professions"(Altmann, 2012, p.84). Nursing is a vocation entrusted with human beings where the smallest mistake can be detrimental to someone's health, therefore nothing short of excellent quality of care will do. Aside from the nursing governing institutions, even the general public seems to favor a more qualified nurse at the bedside; " 76% of the public thinks nurses should have 4 years of education or more past high school to perform the duties of their job"(Altmann, 2011, p.257).

With all the research presented, even if certain studies do not have enough evidence to display modalities that clearly link lower mortality rates to BSN prepared nurses, the fact is that nurses with a BSN degree have significantly higher theoretical preparation than the associate degree prepared nurses. This quality is linked to better work environments, which provide professional opportunities to use this knowledge to ultimately enhance the quality of patient care (Weinberg, Miner, Perloff, 2012). And in today's constantly evolving society, the upfront cost of a better education will definitely be justifiable in the end.

References

Altmann, T. K. (2012). Nurses' Attitudes Toward Continuing Formal Education: A Comparison by Level of Education and Geography.Nursing Education Perspectives, 33(2), 80-84. doi:10.5480/1536-5026-33.2.80

Altmann, T. K. (2011). Registered nurses returning to school for a bachelor's degree in nursing: Issues emerging from a meta-analysis of the research. Contemporary Nurse: A Journal For The Australian Nursing Profession, 39(2), 256-272.

Grand Canyon University. (2015). Grand Canyon University College of Nursing Philosophy
[pdf]. Retrieved from http://lc.gcu.edu/

Rosseter R. J. (2015). Creating a More Highly Qualified Nursing Workforce. Retrieved from American Association of Colleges of Nursing website: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce

Weinberg, D. B., Cooney-Miner, D., & Perloff, J. N. (2012). Analyzing the Relationship Between Nursing Education and Patient Outcomes. Journal Of Nursing Regulation, 3(2), 4-10.