Running head: Educational Preparation in Nursing

Educational Preparation in Nursing
Steven Justo

Abstract
The leaders of nursing throughout history have shaped not only the practice of the nursing, but also entrance to the profession via, Diploma, Associates Degree and Bachelors Degree programs. While multiple avenues exist to gain entry into the nursing profession as a Registered Nurse (RN), not all nurses are equally prepared for a professional career in nursing. An aging Baby Boomer generation entering into retirement relying more heavily on the healthcare system, will create a greater demand not only for Registered Nurses with Bachelors Degrees, but furthermore for those RNs with advanced post-graduate degree education to be able to manage an ever changing and challenged healthcare landscape.

Educational Preparation
The purpose of this paper is to examine the differences between Diploma, Associates Degree, and Bachelors Degree prepared nurses who take the National Council of State Boards of Nursing’s (NCSBN’s) Nursing Licensure Exam for Registered Nurses (NCLEX-RN) exam. While all three types of nurses are authorized to take and pass the NCLEX board exams for licensure, not all RNs are equally prepared to handle and manage the complex and ever changing healthcare landscape and in particular regards to preparedness of practice of the professional nurse.
Differences in Competencies
Diminishing Diploma Programs
Established in 1873, Massachusetts General Hospital initiated the very first formal nursing educational program in the United States (Friberg and Creasia 2011). Hospital based diploma programs were the dominant mode of entry to the nursing profession from their inception in the late 1800s through the middle 1900s with approximately 944 programs in the U.S. (Friberg, and Creasia). Maintaining diploma programs within hospitals became less feasible after the great depression as nursing students were increasingly used to meet hospital staffing needs rather than function in the student role. Diploma nursing programs have ultimately succumbed to the high cost of running these programs as the number of college nursing options have also increased. (Friberg, and Creasia).
As the number of diploma nursing programs dwindles, the number of nurses who entered the profession via this method have also decreased compared to their Associates Degree in Nursing (ADN) and Bachelors of Science in Nursing (BSN) prepared peers. Current nurses who entered into the profession by apprenticing through a diploma program are often excellent technically skilled nurses. At Northwest Community Hospital (NCH) in Arlington Heights, IL the hospital where this author works, one of the Clinical Nurse Consultants (CNC) working the night shift is a diploma prepared nurse with 35 years experience (20 of which were gained from the ICU and ER). While she does not have any further nursing degree, she has maintained her education through several certifications through the American Association of Critical-Care Nurses (AACN) to keep up to date with her clinical skills. She has worked in multiple capacities at our hospital including staff nurse, charge nurse, unit manager, and administrative nursing supervisor, and now as a CNC. Unfortunately as our hospital has achieved Magnet status, she has stepped aside from her administrative and managerial positions since all nurse managers and nurse leaders now require at least a BSN or graduate degree in nursing (American Association of Colleges of Nursing, 2012). Since achieving magnet status, NCH has followed suit, incorporating a policy that employees in managerial nursing positions must have at least a BSN, and as well as plans to have 80% baccalaureate prepared RN workforce by 2020.
Associates Degree

Upon completion of an ADN program, students are also prepared and allowed to sit for the NCLEX-RN exam. ADN nurses are technically prepared nurses able to provide direct care to patients with common, well-defined nursing diagnoses while also considering their clients’ familial relationships (Hood, 2010). At NCH, many ADN staff nurses follow clearly defined protocols and procedures when applying the nursing process to care for their patients. ADN nurses often use basic therapeutic communication skills with a focal client group and coordinate efforts with other health team members to meet client-focused needs (Hood). One example of ADN nurses following standard practice is with wound care. The standard practice at NCH for wound care includes basic wound assessment in terms of size, length, width, depth, color, exudate, drainage, odor, pain, etc. ADN prepared nurses are also technically sound competencied nurses practicing safe basic nursing care. ADN competencies tend to center around caregiver, counselor and educator roles (Hood, 2010).
Bachelors Degree
According to Hood (2010), the difference between the communication between a patient and an ADN nurse is that the ADN nurse recognizes the patient's need for information and modifies the standardized care plans for the patient. However, the BSN nurse according to Hood assess the patients individualized teaching needs and designs individualized teaching plans to meet the patients needs.
Following the prior example in wound care, the BSN prepared nurse assesses the patient and then tailors and prepares an individualized teaching plan to meet the patient’s needs. For example, the BSN nurse, aside from the basic wound assessment, will ask more in-depth questions and take into account a more holistic approach in assessing the patient. They consider evidenced based practice regarding wound care, as well as collaborate with the Infectious Disease Doctor to develop a plan of care for the wound care patient. The BSN nurse engages in independent thinking to provide nursing care considering multiple differing health alterations within a variety of settings, including the community (Hood, 2010).
Moving Towards a more Highly Educated Nursing Workforce The American Association of Colleges of Nursing points to studies correlating baccalaureate education and lower mortality rates. They point to several studies wherein patient outcomes would be improved when the nursing workforce had a higher proportion of staff nurses with at least their BSN (American Association of Colleges of Nursing, 2012).
Conclusion
In conclusion, current entrance to the nursing profession includes Diploma, Associates Degree and Bachelors Degree programs. As feasibility of maintaining Diploma programs decreases, ADN and BSN programs will dominate the majority of nurses entering the profession.
With a changing healthcare landscape, nurses will be required to assist and manage care of a patient across a continuum of care environments. Current ADN prepared nurses have an edge over Diploma nurses in pursuing further education as ADN credits are often accepted in BSN programs. BSN prepared nurses are comprehensively trained to address complex changing needs of the patient. The professional nurse will need to be prepared to manage diverse patient and healthcare situations and be able to think, assess and act independently within the legal and ethical parameters of nursing. Magnet hospitals looking to differentiate and exemplify nursing excellence with superior patient outcomes will soon require 80% of the nursing staff to have their BSN. As an aging Baby Boomer generation entering into retirement relies more heavily on the healthcare system, there will be greater demand not only for Registered Nurses with Bachelors Degrees, but furthermore for those RNs with advanced post-graduate degree education to be able to manage an ever changing and challenged healthcare landscape.

References
American Association of Colleges of Nursing, (2012). Fact Sheet: Creating a More Highly Qualified Nursing Workforce. Retrieved from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf on August, 12 2012.

Friberg, Creasia and. (2011). Conceptual Foundations: The Bridge to Professional Nursing Practice, 5th Edition. Mosby. Retrieved from <vbk:978-0-323-06869-7#outline(2.3.1)>.
Hood, L. J., & Leddy, S. K. (2010). Conceptual bases of professional nursing (7th ed.). Philadelphia: Lippincott Williams & Wilkins. |